Healthcare Provider Details

I. General information

NPI: 1760298186
Provider Name (Legal Business Name): KRYSTAL DENISE HESTER-SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2024
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

874 UNION AVE RM 325
MEMPHIS TN
38103-3514
US

IV. Provider business mailing address

874 UNION AVE RM 325
MEMPHIS TN
38103-3514
US

V. Phone/Fax

Practice location:
  • Phone: 901-448-6128
  • Fax:
Mailing address:
  • Phone: 901-448-6128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number43000
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: