Healthcare Provider Details

I. General information

NPI: 1053004069
Provider Name (Legal Business Name): MEMPHIS BUSINESS ACADEMY MIDDLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2023
Last Update Date: 05/26/2023
Certification Date: 05/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 FRAYSER BLVD.
MEMPHIS TN
38127-5823
US

IV. Provider business mailing address

2450 FRAYSER BLVD.
MEMPHIS TN
38127-5823
US

V. Phone/Fax

Practice location:
  • Phone: 901-358-1652
  • Fax:
Mailing address:
  • Phone: 901-358-1652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name: NANCY SUE REEVES
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 318-207-4649