Healthcare Provider Details

I. General information

NPI: 1023462868
Provider Name (Legal Business Name): AMY ELIZABETH RAGSDALE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2016
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6401 POPLAR AVE STE 300
MEMPHIS TN
38119-4810
US

IV. Provider business mailing address

9800 SHELBYVILLE RD STE 220
LOUISVILLE KY
40223-2992
US

V. Phone/Fax

Practice location:
  • Phone: 901-757-6100
  • Fax: 855-656-7325
Mailing address:
  • Phone: 502-429-8585
  • Fax: 855-656-7325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberE-14133
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number3808
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: