Healthcare Provider Details

I. General information

NPI: 1508232067
Provider Name (Legal Business Name): KATRINA BEW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2015
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 WESLEY DR
MEMPHIS TN
38116-6426
US

IV. Provider business mailing address

30 BURTON HILLS BLVD STE 175
NASHVILLE TN
37215-6403
US

V. Phone/Fax

Practice location:
  • Phone: 901-481-2203
  • Fax:
Mailing address:
  • Phone: 615-988-2014
  • Fax: 615-864-7565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number20239
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: