Healthcare Provider Details

I. General information

NPI: 1609302546
Provider Name (Legal Business Name): CHERYL BEENE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 06/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 UNION AVE STE 475
MEMPHIS TN
38104
US

IV. Provider business mailing address

P O BOX 1000 DEPT 960
MEMPHIS TN
38148-0001
US

V. Phone/Fax

Practice location:
  • Phone: 901-274-2643
  • Fax: 901-726-4237
Mailing address:
  • Phone: 901-763-0200
  • Fax: 901-761-4002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA005145
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number24121
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: