Healthcare Provider Details

I. General information

NPI: 1003813023
Provider Name (Legal Business Name): KATRINA H DENEGRI GNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATRINA A HARDIN GNP

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1726 POPLAR AVE
MEMPHIS TN
38104-6426
US

IV. Provider business mailing address

PO BOX 820406
MEMPHIS TN
38182-0406
US

V. Phone/Fax

Practice location:
  • Phone: 901-725-0872
  • Fax: 901-278-6934
Mailing address:
  • Phone: 901-725-0872
  • Fax: 901-278-6934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPN0000008186
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: