Healthcare Provider Details

I. General information

NPI: 1477186476
Provider Name (Legal Business Name): JOSHUA MAYBERRY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2020
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 E EH CRUMP BLVD
MEMPHIS TN
38126-5310
US

IV. Provider business mailing address

8869 CAMPALDINO AVE
CORDOVA TN
38018-3631
US

V. Phone/Fax

Practice location:
  • Phone: 901-261-2000
  • Fax:
Mailing address:
  • Phone: 731-618-6177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000027054
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: