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General NPI Number Information
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NPI Number | 1417736372
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Entity Type | Individual
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Provider Name | ANTTRENIKA ANDERSON
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Gender | Female
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Dates
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Enumeration Date | 09/28/2023
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Last Update Date | 09/05/2024
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Provider Practice Location Address
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Address Line | 2262 S GERMANTOWN RD
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City | GERMANTOWN
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State | TN
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Zip | 38138-3805
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Country | US
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Telephone | 901-753-4300
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Fax |
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Provider Business Mailing Address
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Address Line | 3645 BOEINGSHIRE DR
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City | MEMPHIS
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State | TN
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Zip | 38116-5014
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Country | US
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Telephone | 901-503-7567
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Fax |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 34680
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License Number State | TN
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