Healthcare Provider Details

I. General information

NPI: 1992973739
Provider Name (Legal Business Name): RACHAEL DAVIS BARTOSCH ACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 10/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6027 WALNUT GROVE RD STE 206
MEMPHIS TN
38120-2127
US

IV. Provider business mailing address

PO BOX 405827
ATLANTA GA
30384-5800
US

V. Phone/Fax

Practice location:
  • Phone: 901-226-5151
  • Fax: 901-226-3775
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number17286
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number17286
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: