Healthcare Provider Details

I. General information

NPI: 1841373206
Provider Name (Legal Business Name): EVELYN S STILES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2006
Last Update Date: 10/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2911 BRUNSWICK RD
MEMPHIS TN
38136-0001
US

IV. Provider business mailing address

8595 TIMBER CREEK DR
CORDOVA TN
38018-3597
US

V. Phone/Fax

Practice location:
  • Phone: 901-377-4757
  • Fax:
Mailing address:
  • Phone: 901-219-4504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000007827
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: