Healthcare Provider Details

I. General information

NPI: 1518663491
Provider Name (Legal Business Name): DROPNSWAP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2023
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4069 LONGHOLLOW DR
MEMPHIS TN
38128-3017
US

IV. Provider business mailing address

4069 LONGHOLLOW DR
MEMPHIS TN
38128-3017
US

V. Phone/Fax

Practice location:
  • Phone: 901-831-0741
  • Fax:
Mailing address:
  • Phone: 901-831-0741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: KENDRA BUTLER
Title or Position: CLINICAL DIRECTOR
Credential:
Phone: 901-831-0741