Healthcare Provider Details

I. General information

NPI: 1306294327
Provider Name (Legal Business Name): KRISTINA MICHELLE FAVALORO DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2016
Last Update Date: 07/21/2022
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2986 KATE BOND RD
BARTLETT TN
38133-4003
US

IV. Provider business mailing address

5050 POPLAR AVE STE 800
MEMPHIS TN
38157-0800
US

V. Phone/Fax

Practice location:
  • Phone: 901-820-7000
  • Fax:
Mailing address:
  • Phone: 901-335-8317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number196307
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number22986
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: