Healthcare Provider Details

I. General information

NPI: 1467874750
Provider Name (Legal Business Name): PAULA RENA PRICE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2014
Last Update Date: 01/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8295 TOURNAMENT DR SUITE150
MEMPHIS TN
38125-8906
US

IV. Provider business mailing address

1026 E ALCY RD
MEMPHIS TN
38106-7906
US

V. Phone/Fax

Practice location:
  • Phone: 866-563-7772
  • Fax: 901-255-0758
Mailing address:
  • Phone: 901-361-0134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN0000142804
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: