Healthcare Provider Details

I. General information

NPI: 1962232926
Provider Name (Legal Business Name): ANTHONY KEEGAN WHITE II
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2024
Last Update Date: 08/05/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

534 N 2ND ST
MEMPHIS TN
38105-1632
US

IV. Provider business mailing address

3406 MOWREY CV
BARTLETT TN
38135-2519
US

V. Phone/Fax

Practice location:
  • Phone: 901-448-1956
  • Fax:
Mailing address:
  • Phone: 901-326-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: