Healthcare Provider Details

I. General information

NPI: 1730603192
Provider Name (Legal Business Name): DANIELLE DEANNA AVERY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2017
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8060 WOLF RIVER BLVD
GERMANTOWN TN
38138-1727
US

IV. Provider business mailing address

8811 E PLANTATION OAKS DR
CORDOVA TN
38018-7477
US

V. Phone/Fax

Practice location:
  • Phone: 901-271-1000
  • Fax:
Mailing address:
  • Phone: 901-518-8192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number902203
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: