Healthcare Provider Details

I. General information

NPI: 1124931233
Provider Name (Legal Business Name): MICHAEL LLOYD CHIPMAN AG-ACNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6025 WALNUT GROVE RD STE 301
MEMPHIS TN
38120-2123
US

IV. Provider business mailing address

45 POPPY
ATOKA TN
38004-5243
US

V. Phone/Fax

Practice location:
  • Phone: 901-226-0456
  • Fax: 901-226-0458
Mailing address:
  • Phone: 901-226-0456
  • Fax: 901-226-0458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number43155
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: