Healthcare Provider Details

I. General information

NPI: 1982913588
Provider Name (Legal Business Name): SHIRLEY A RHODES-MCDONALD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2010
Last Update Date: 04/07/2020
Certification Date: 04/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6670 STAGE RD
BARTLETT TN
38134-3810
US

IV. Provider business mailing address

6670 STAGE RD
BARTLETT TN
38134-3810
US

V. Phone/Fax

Practice location:
  • Phone: 901-384-9000
  • Fax:
Mailing address:
  • Phone: 901-384-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number161333
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number15551
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: