Healthcare Provider Details

I. General information

NPI: 1154219087
Provider Name (Legal Business Name): MEGAN KENNELLY CARTER RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MEGAN KENNELLY MURPHY

II. Dates (important events)

Enumeration Date: 06/27/2025
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

946 TATUM RD
MEMPHIS TN
38122-2522
US

IV. Provider business mailing address

946 TATUM RD
MEMPHIS TN
38122-2522
US

V. Phone/Fax

Practice location:
  • Phone: 901-591-6159
  • Fax:
Mailing address:
  • Phone: 901-591-6159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number0000212029
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: