Healthcare Provider Details

I. General information

NPI: 1881247740
Provider Name (Legal Business Name): MEKEILAH NEVAUN JOHNSON APRN, FNP-BC, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2019
Last Update Date: 12/11/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3082 KIRBY WHITTEN ROAD
BARTLETT TN
38134
US

IV. Provider business mailing address

PO BOX 34834
MEMPHIS TN
38184-0834
US

V. Phone/Fax

Practice location:
  • Phone: 901-250-9080
  • Fax:
Mailing address:
  • Phone: 901-236-6564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26203
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: