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General NPI Number Information
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NPI Number | 1023550100
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Entity Type | Organization
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Legal Business Name | YOUR ENT, PLLC
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Dates
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Enumeration Date | 11/07/2016
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Last Update Date | 11/29/2016
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Provider Practice Location Address
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Address Line | 2028 W POPLAR AVE SUITE 112
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City | COLLIERVILLE
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State | TN
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Zip | 38017-0618
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Country | US
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Telephone | 901-861-2526
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Fax | 901-861-2527
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Provider Business Mailing Address
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Address Line | 2028 W POPLAR AVE SUITE 112
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City | COLLIERVILLE
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State | TN
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Zip | 38017-0618
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Country | US
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Telephone | 901-861-2526
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Fax | 901-861-2527
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Authorized Official
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Title or Position | OWNER
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Name | MRS. KATHRYN LENDERMAN KING
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Credential | FNP
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Telephone | 901-861-2526
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 15081
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License Number State | TN
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