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General NPI Number Information
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NPI Number | 1013703966
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Entity Type | Individual
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Provider Name | CASSIDY THETFORD AGNP-C
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Gender | Female
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Dates
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Enumeration Date | 04/17/2025
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 6019 WALNUT GROVE RD
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City | MEMPHIS
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State | TN
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Zip | 38120-2113
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Country | US
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Telephone | 901-226-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 965 RIDGE LAKE BLVD STE 315
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City | MEMPHIS
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State | TN
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Zip | 38120-9401
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Country | US
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Telephone | 877-348-1281
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Fax | 901-227-3206
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 38571
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License Number State | TN
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