Healthcare Provider Details

I. General information

NPI: 1962047647
Provider Name (Legal Business Name): COURTNEY KERR SPELLINGS NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2019
Last Update Date: 01/16/2022
Certification Date: 01/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

848 ADAMS AVE
MEMPHIS TN
38103-2816
US

IV. Provider business mailing address

853 JEFFERSON AVE # E206
MEMPHIS TN
38103-2804
US

V. Phone/Fax

Practice location:
  • Phone: 901-581-5160
  • Fax:
Mailing address:
  • Phone: 901-581-5160
  • Fax: 901-302-2495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number211834
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number30725
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: