Healthcare Provider Details

I. General information

NPI: 1619840188
Provider Name (Legal Business Name): MADISON B ESCALERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 UNION AVE # 157
MEMPHIS TN
38104-3725
US

IV. Provider business mailing address

1099 HINES GIN RD
SELMER TN
38375-5105
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax:
Mailing address:
  • Phone: 731-453-5688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB1410032
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: