Healthcare Provider Details

I. General information

NPI: 1508007972
Provider Name (Legal Business Name): CARROLL ANNE KEITH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2009
Last Update Date: 03/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 UNION AVE
MEMPHIS TN
38104-6638
US

IV. Provider business mailing address

3994 ARGONNE ST
MEMPHIS TN
38127-3906
US

V. Phone/Fax

Practice location:
  • Phone: 901-516-7000
  • Fax:
Mailing address:
  • Phone: 901-212-3662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License Number156388
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN0000158915
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: