Healthcare Provider Details

I. General information

NPI: 1306133848
Provider Name (Legal Business Name): FLOTYL K. GRESHAM MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2011
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8071 WINCHESTER RD
MEMPHIS TN
38125-8206
US

IV. Provider business mailing address

8071 WINCHESTER RD STE 3
MEMPHIS TN
38125-8206
US

V. Phone/Fax

Practice location:
  • Phone: 901-756-6056
  • Fax: 901-624-0702
Mailing address:
  • Phone: 901-756-6056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA810422
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000015939
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: