Healthcare Provider Details

I. General information

NPI: 1427984889
Provider Name (Legal Business Name): ANJANETTE ANDERSON
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 153
MEMPHIS TN
38101-0153
US

IV. Provider business mailing address

PO BOX 153
MEMPHIS TN
38101-0153
US

V. Phone/Fax

Practice location:
  • Phone: 901-595-3300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number37373
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: