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NPI Code Detail

MEDICARE: TARA YVETTE MABON FNP

MEDICARE: TARA YVETTE MABON FNP
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
1363LF0000XFamily Nurse Practitioner0000013381TN

General Provider Information

NPI Number : 1619136306
Entity Type Code : Individual
Provider Name (Legal Business Name) : TARA YVETTE MABON FNP
Provider Business Mailing Address
First Line : 877 JEFFERSON AVE
Second Line : ATTN: PROVIDER ENROLLMENT
City : MEMPHIS
State : TN
Zip : 38103-2807
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2500 PERES AVE
Second Line :
City : MEMPHIS
State : TN
Zip : 38108-1660
Country : US
Telephone Number : 901-515-5500
Fax Number : 901-458-5591
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2008
Last Update Date : 01/03/2017

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Directions to “ TARA YVETTE MABON FNP” Practice Location

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