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General NPI Number Information
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NPI Number | 1053974949
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Entity Type | Individual
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Provider Name | CAITLIN MORAN BROCKENSHIRE MD
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Gender | Female
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Dates
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Enumeration Date | 04/17/2019
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Last Update Date | 07/17/2024
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Provider Practice Location Address
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Address Line | 6325 HUMPHREYS BLVD
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City | MEMPHIS
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State | TN
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Zip | 38120-2300
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Country | US
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Telephone | 901-522-7700
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Fax | 901-522-2600
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Provider Business Mailing Address
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Address Line | 6325 HUMPHREYS BLVD
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City | MEMPHIS
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State | TN
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Zip | 38120-2300
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Country | US
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Telephone | 901-522-7700
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Fax | 901-522-2600
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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 | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 67573
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 2084V0102X
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Taxonomy Name | Vascular Neurology Physician
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License Number | 67573
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 33205
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License Number State | MS
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