Healthcare Provider Details

I. General information

NPI: 1770193344
Provider Name (Legal Business Name): JAMES ANTHONY PASS JR. MSN, APRN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2020
Last Update Date: 08/07/2020
Certification Date: 08/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 WOODLAND TRACE LN
CORDOVA TN
38018-6609
US

IV. Provider business mailing address

3023 SCHEIBLER RD
MEMPHIS TN
38128-4906
US

V. Phone/Fax

Practice location:
  • Phone: 901-626-3515
  • Fax:
Mailing address:
  • Phone: 901-314-3994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number27871
License Number StateTN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: