Healthcare Provider Details

I. General information

NPI: 1336900315
Provider Name (Legal Business Name): KARYN BEDNAREK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2024
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2262 S GERMANTOWN RD
GERMANTOWN TN
38138-3805
US

IV. Provider business mailing address

2262 S GERMANTOWN RD
GERMANTOWN TN
38138-3805
US

V. Phone/Fax

Practice location:
  • Phone: 901-496-2974
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: