Healthcare Provider Details

I. General information

NPI: 1174347322
Provider Name (Legal Business Name): ANDREA MADGENA STODDART-HARRISON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2024
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5959 PARK AVE
MEMPHIS TN
38119-5198
US

IV. Provider business mailing address

9219 CRIMSON MILL DR
CORDOVA TN
38016-0936
US

V. Phone/Fax

Practice location:
  • Phone: 931-302-5040
  • Fax:
Mailing address:
  • Phone: 901-707-9885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number37355
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number37355
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: