Healthcare Provider Details

I. General information

NPI: 1013525187
Provider Name (Legal Business Name): KERSHAW PRIMARY CARE AND WEIGHT LOSS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2020
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6005 PARK AVE STE 826B
MEMPHIS TN
38119-5223
US

IV. Provider business mailing address

6005 PARK AVE STE 826B
MEMPHIS TN
38119-5223
US

V. Phone/Fax

Practice location:
  • Phone: 901-519-4680
  • Fax:
Mailing address:
  • Phone: 901-519-4680
  • Fax: 901-417-8914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: VALARIE KERSHAW
Title or Position: OWNER/ PMHNP-BC/ APRN
Credential: APRN, PMHNP
Phone: 901-519-4680