Healthcare Provider Details

I. General information

NPI: 1891771754
Provider Name (Legal Business Name): REGINA ANDERSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 HAYNES ST
MEMPHIS TN
38114-3374
US

IV. Provider business mailing address

877 JEFFERSON AVE 5TH FLOOR ADAMS PAVILION
MEMPHIS TN
38103-2807
US

V. Phone/Fax

Practice location:
  • Phone: 901-515-5200
  • Fax: 901-323-6807
Mailing address:
  • Phone: 901-515-4529
  • Fax: 901-272-0292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN 89402
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: