Healthcare Provider Details

I. General information

NPI: 1649288424
Provider Name (Legal Business Name): CLYDE H ELDER JR. APRN,BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3461 AUSTIN PEAY HWY
MEMPHIS TN
38128-3801
US

IV. Provider business mailing address

6785 RICKS RD
ARLINGTON TN
38002-6907
US

V. Phone/Fax

Practice location:
  • Phone: 901-261-4500
  • Fax: 901-261-4511
Mailing address:
  • Phone: 901-873-3923
  • Fax: 901-261-4511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberRN0000048298
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: