Healthcare Provider Details

I. General information

NPI: 1730870247
Provider Name (Legal Business Name): CHRISTINA MARIE WILLIS DNP, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTINA MARIE FLECK RN, BSN

II. Dates (important events)

Enumeration Date: 05/16/2023
Last Update Date: 01/14/2026
Certification Date: 01/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 POPLAR AVE STE 501
MEMPHIS TN
38112-3255
US

IV. Provider business mailing address

2400 POPLAR AVE STE 501
MEMPHIS TN
38112-3255
US

V. Phone/Fax

Practice location:
  • Phone: 901-209-0195
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number244036
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number39489
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: