Healthcare Provider Details

I. General information

NPI: 1902572951
Provider Name (Legal Business Name): MAEGAN MARIE LYTLE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2021
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

943 WHITNEY AVE
MEMPHIS TN
38127-7734
US

IV. Provider business mailing address

6727 N QUAIL HOLLOW RD
MEMPHIS TN
38120-4463
US

V. Phone/Fax

Practice location:
  • Phone: 901-358-0326
  • Fax:
Mailing address:
  • Phone: 901-351-9771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000029030
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: