Healthcare Provider Details

I. General information

NPI: 1972447159
Provider Name (Legal Business Name): JAIMERIN M PIGRUM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4740 GERTRUDE DR
MEMPHIS TN
38125-5750
US

IV. Provider business mailing address

4740 GERTRUDE DR
MEMPHIS TN
38125-5750
US

V. Phone/Fax

Practice location:
  • Phone: 901-949-6992
  • Fax:
Mailing address:
  • Phone: 901-949-6992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8378
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: