MEDICARE: ROSE M TOWNLEY-BAKEWELL APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	110406	NE
2	363LA2200X	Adult Health Nurse Practitioner	16797	TN

General Provider Information

NPI Number	:	1154392967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSE M TOWNLEY-BAKEWELL APRN

Provider Business Mailing Address
First Line	:	742 WEST DR
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38112-1729
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1325 EASTMORELAND AVE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38104-3519
Country	:	US
Telephone Number	:	901-276-0249
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	01/09/2019

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