Healthcare Provider Details

I. General information

NPI: 1285372813
Provider Name (Legal Business Name): JAVITA GLASPER PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2022
Last Update Date: 05/24/2022
Certification Date: 05/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1087 ALICE AVE
MEMPHIS TN
38106-6543
US

IV. Provider business mailing address

6070 TALL WILLOW DR
MEMPHIS TN
38141-7628
US

V. Phone/Fax

Practice location:
  • Phone: 901-821-5841
  • Fax:
Mailing address:
  • Phone: 901-644-7794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number31375
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: