Healthcare Provider Details

I. General information

NPI: 1386954683
Provider Name (Legal Business Name): MY NP FAMILY HEALTH AND WELLNESS CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2010
Last Update Date: 10/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1061 S REMBERT ST
MEMPHIS TN
38104-5651
US

IV. Provider business mailing address

4730 RIVERDALE RD SUITE 6
MEMPHIS TN
38141-8583
US

V. Phone/Fax

Practice location:
  • Phone: 901-481-5444
  • Fax:
Mailing address:
  • Phone: 901-481-5444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: LORETTA ADAIR
Title or Position: MEDICAL DIRECTOR
Credential: NP
Phone: 901-481-5444