Healthcare Provider Details

I. General information

NPI: 1669141669
Provider Name (Legal Business Name): KRISTI SHERIDAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2021
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

262 DANNY THOMAS PL
MEMPHIS TN
38105-3678
US

IV. Provider business mailing address

4701 FLAMINGO RD
MEMPHIS TN
38117-6111
US

V. Phone/Fax

Practice location:
  • Phone: 15-953-3009
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number35648
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN259102
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: