Healthcare Provider Details

I. General information

NPI: 1770579450
Provider Name (Legal Business Name): SHERRY BUCKLEY-CLAYTON APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHERRY ANN BUCKLEY APN

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

877 JEFFERSON AVE
MEMPHIS TN
38103-2807
US

IV. Provider business mailing address

877 JEFFERSON AVE ATTN: PROVIDER ENROLLMENT
MEMPHIS TN
38103-2807
US

V. Phone/Fax

Practice location:
  • Phone: 901-448-8140
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number66037
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN5939
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: