Healthcare Provider Details

I. General information

NPI: 1629309463
Provider Name (Legal Business Name): CATHERINE TALBOT LACKIE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CATHERINE PAGE TALBOT FNP

II. Dates (important events)

Enumeration Date: 01/19/2010
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6286 BRIARCREST AVE STE 200
MEMPHIS TN
38120-4023
US

IV. Provider business mailing address

6077 PRIMACY PKWY STE 140
MEMPHIS TN
38119-5742
US

V. Phone/Fax

Practice location:
  • Phone: 901-641-3000
  • Fax: 901-259-1698
Mailing address:
  • Phone: 901-725-8347
  • Fax: 901-259-7637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14930
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number168742
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: