Healthcare Provider Details

I. General information

NPI: 1205376712
Provider Name (Legal Business Name): GABRIELLE MAYS VICTOR FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 UNION AVE STE 965
MEMPHIS TN
38104-6638
US

IV. Provider business mailing address

1211 UNION AVE STE 495
MEMPHIS TN
38104-6656
US

V. Phone/Fax

Practice location:
  • Phone: 901-435-8550
  • Fax: 901-516-0933
Mailing address:
  • Phone: 901-507-6600
  • Fax: 901-507-6599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number22354
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: