| Lea Brainerd, Pa-c | |
|
4646 Poplar Ave Ste 409 Memphis TN 38117-4434 | |
| (901) 582-7243 | |
| (901) 425-9853 |
| Full Name | Lea Brainerd, Pa-c |
|---|---|
| Speciality | Physician Assistant |
| Location | 4646 Poplar Ave Ste 409, Memphis, Tennessee |
| Authorized Official Name and Position | Lea Hayley Brainerd (CEO) |
| Authorized Official Contact | 9016121486 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lea Brainerd, Pa-c 1028 Cresthaven Rd Ste 200 Memphis TN 38119-3867 Ph: (901) 612-1486 | Lea Brainerd, Pa-c 4646 Poplar Ave Ste 409 Memphis TN 38117-4434 Ph: (901) 582-7243 |
| NPI Number | 1770291189 |
|---|---|
| Provider Enumeration Date | 11/14/2022 |
| Last Update Date | 09/18/2024 |
| Certification Date | 09/18/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770291189 | NPI | - | NPPES |
| PA1099 | Other | WY | STATE LICENSE |
| 4706 | Other | TN | LICENSE |
| PA00599 | Other | MS | STATE LICENSE |
| TPPA490 | Other | FL | STATE LICENSE |
| UC-51980AFD-1B01-483 | Other | PROFESSIONAL CERTIFIED COACH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (NU) | Secondary |
| 363A00000X | Physician Assistant | (NU) | Primary |
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