Healthcare Provider Details

I. General information

NPI: 1972059491
Provider Name (Legal Business Name): DESIREE PERKINS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DESIREE SHAMMAS CRNA

II. Dates (important events)

Enumeration Date: 08/26/2016
Last Update Date: 06/13/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5545 MURRAY AVE STE 130
MEMPHIS TN
38119-3861
US

IV. Provider business mailing address

5545 MURRAY AVE STE 130
MEMPHIS TN
38119-3861
US

V. Phone/Fax

Practice location:
  • Phone: 901-682-2872
  • Fax: 901-682-9316
Mailing address:
  • Phone: 901-682-2872
  • Fax: 901-682-9316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number179239
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: