Healthcare Provider Details

I. General information

NPI: 1215869284
Provider Name (Legal Business Name): MARVETTE DAVETA HULLETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9485 CRESTWYN HILLS CV
MEMPHIS TN
38125-8515
US

IV. Provider business mailing address

9485 CRESTWYN HILLS CV
MEMPHIS TN
38125-8515
US

V. Phone/Fax

Practice location:
  • Phone: 901-248-1500
  • Fax:
Mailing address:
  • Phone: 901-248-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number41777
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: