Healthcare Provider Details

I. General information

NPI: 1497619803
Provider Name (Legal Business Name): TIERRA MITCHELL
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 HUMPHREYS CENTER DR STE 307
MEMPHIS TN
38120-2363
US

IV. Provider business mailing address

5466 BANBURY AVE
MEMPHIS TN
38135-2814
US

V. Phone/Fax

Practice location:
  • Phone: 901-240-3225
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR1000X
TaxonomyReproductive Endocrinology/Infertility Registered Nurse
License Number265772
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: