Healthcare Provider Details

I. General information

NPI: 1689895245
Provider Name (Legal Business Name): JUSTIN D MCADOO DNP, CRNA, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 01/05/2025
Certification Date: 01/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6373 N QUAIL HOLLOW RD STE 101
MEMPHIS TN
38120-1405
US

IV. Provider business mailing address

6373 N QUAIL HOLLOW RD STE 101
MEMPHIS TN
38120-1405
US

V. Phone/Fax

Practice location:
  • Phone: 901-871-0170
  • Fax:
Mailing address:
  • Phone: 901-871-0170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number141683
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number225137
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number906011
License Number StateMS
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberC003113
License Number StateAR
# 5
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number12785
License Number StateTN
# 6
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number901353
License Number StateMS
# 7
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number12785
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: