Healthcare Provider Details

I. General information

NPI: 1003115056
Provider Name (Legal Business Name): KENNETH M HARSHMAN R.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2011
Last Update Date: 03/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4041 KNIGHT ARNOLD RD
MEMPHIS TN
38118-2128
US

IV. Provider business mailing address

4041 KNIGHT ARNOLD RD
MEMPHIS TN
38118-2128
US

V. Phone/Fax

Practice location:
  • Phone: 901-821-5841
  • Fax: 901-821-5662
Mailing address:
  • Phone: 901-821-5600
  • Fax: 901-821-5662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number158245
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: