Healthcare Provider Details

I. General information

NPI: 1588067078
Provider Name (Legal Business Name): ADA TERESA OBI FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2014
Last Update Date: 06/03/2022
Certification Date: 06/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4593 ELVIS PRESLEY BLVD STE 101
MEMPHIS TN
38116-1511
US

IV. Provider business mailing address

3104 VALLEY CREST DR
MCKINNEY TX
75070-7796
US

V. Phone/Fax

Practice location:
  • Phone: 901-261-7338
  • Fax: 901-345-0909
Mailing address:
  • Phone: 731-217-6179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19141
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: