=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275531246
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUDITH BERNER BRITTINGHAM NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2005
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3175 LENOX PARK BLVD STE 412
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38115-4256
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-273-2350
-----------------------------------------------------
Fax | 901-273-2351
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8273 STILL OAKS CV
-----------------------------------------------------
City | CORDOVA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38018-9140
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-755-8273
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 0000042769
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------