Healthcare Provider Details

I. General information

NPI: 1598058356
Provider Name (Legal Business Name): JENNIFER L KIRBY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 05/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3960 NEW COVINGTON PIKE
MEMPHIS TN
38128-2504
US

IV. Provider business mailing address

8010 STAGE HILLS BLVD
BARTLETT TN
38133-4032
US

V. Phone/Fax

Practice location:
  • Phone: 901-516-5200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number15656
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: