Healthcare Provider Details

I. General information

NPI: 1316672140
Provider Name (Legal Business Name): MRS. ADRIENNE N WALTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2022
Last Update Date: 04/27/2025
Certification Date: 04/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3244 HORN LAKE RD
MEMPHIS TN
38109-3210
US

IV. Provider business mailing address

8071 WINCHESTER RD
MEMPHIS TN
38125-8206
US

V. Phone/Fax

Practice location:
  • Phone: 901-570-3049
  • Fax:
Mailing address:
  • Phone: 901-756-6056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0002X
TaxonomyHigh-Risk Obstetric Registered Nurse
License Number143029
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number143029
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number33343
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number33343
License Number StateTN
# 5
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number33343
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: