Healthcare Provider Details

I. General information

NPI: 1629022066
Provider Name (Legal Business Name): YVETTE RANDLE OSWELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 01/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5142 STAGE RD SUITE 100
MEMPHIS TN
38134-3164
US

IV. Provider business mailing address

5142 STAGE RD SUITE 100
MEMPHIS TN
38134-3164
US

V. Phone/Fax

Practice location:
  • Phone: 901-382-2040
  • Fax: 901-386-5242
Mailing address:
  • Phone: 901-382-2040
  • Fax: 901-386-5242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberMD0000028644
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number28644
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: