Healthcare Provider Details

I. General information

NPI: 1811659394
Provider Name (Legal Business Name): MOLLY ROLEN MSN, FNP-BC, CCRP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2021
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8040 WOLF RIVER BLVD STE 102
GERMANTOWN TN
38138-1773
US

IV. Provider business mailing address

350 N HUMPHREYS BLVD
MEMPHIS TN
38120-2177
US

V. Phone/Fax

Practice location:
  • Phone: 901-227-7900
  • Fax: 901-227-7920
Mailing address:
  • Phone: 901-226-4003
  • Fax: 901-227-8591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number212006
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number31230
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: