Healthcare Provider Details

I. General information

NPI: 1194956755
Provider Name (Legal Business Name): ELIZABETH K THOMPSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH KAY KACZMAREK APRN

II. Dates (important events)

Enumeration Date: 07/30/2009
Last Update Date: 01/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6029 WALNUT GROVE RD STE C002
MEMPHIS TN
38120-2112
US

IV. Provider business mailing address

6799 GREAT OAKS RD STE 250
MEMPHIS TN
38138-2584
US

V. Phone/Fax

Practice location:
  • Phone: 901-226-3190
  • Fax: 901-226-3191
Mailing address:
  • Phone: 901-685-3490
  • Fax: 901-685-3499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number14039
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number0000014039
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14039
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: