Healthcare Provider Details

I. General information

NPI: 1952629180
Provider Name (Legal Business Name): MARGARET HENDERSON-LEE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2189 WEST ST STE 2
GERMANTOWN TN
38138-3884
US

IV. Provider business mailing address

2189 WEST ST STE 2
MEMPHIS TN
38138-3884
US

V. Phone/Fax

Practice location:
  • Phone: 901-496-0167
  • Fax: 901-421-5967
Mailing address:
  • Phone: 901-496-0167
  • Fax: 901-421-5967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number106888
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14980
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: