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General NPI Number Information
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NPI Number | 1013525187
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Entity Type | Organization
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Legal Business Name | KERSHAW PRIMARY CARE AND WEIGHT LOSS, LLC
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Dates
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Enumeration Date | 07/15/2020
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 6005 PARK AVE STE 826B
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City | MEMPHIS
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State | TN
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Zip | 38119-5223
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Country | US
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Telephone | 901-519-4680
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Fax |
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Provider Business Mailing Address
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Address Line | 6005 PARK AVE STE 826B
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City | MEMPHIS
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State | TN
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Zip | 38119-5223
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Country | US
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Telephone | 901-607-1292
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Fax |
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Authorized Official
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Title or Position | OVER/NURSE PRACTITIONER
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Name | VALARIE KERSHAW-BERRY
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Credential |
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Telephone | 662-902-9883
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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