Healthcare Provider Details

I. General information

NPI: 1326900994
Provider Name (Legal Business Name): TAKIRA MATTHEWS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8090 WALNUT RUN RD
CORDOVA TN
38018-6362
US

IV. Provider business mailing address

4459 CEDAR GLENN DR APT 2
MEMPHIS TN
38128-5853
US

V. Phone/Fax

Practice location:
  • Phone: 901-507-5467
  • Fax:
Mailing address:
  • Phone: 901-507-4367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: