Healthcare Provider Details

I. General information

NPI: 1699289272
Provider Name (Legal Business Name): REONA MICHELLE ESSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2017
Last Update Date: 12/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 EASTMORELAND AVE STE 310
MEMPHIS TN
38104-7544
US

IV. Provider business mailing address

P O BOX 1000 DEPT 457
MEMPHIS TN
38148-0001
US

V. Phone/Fax

Practice location:
  • Phone: 901-272-6010
  • Fax: 901-266-6468
Mailing address:
  • Phone: 901-275-3662
  • Fax: 901-271-0155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number22961
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number22961
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: