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General NPI Number Information
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NPI Number | 1629316963
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Entity Type | Organization
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Legal Business Name | CAREMART PLUS
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Dates
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Enumeration Date | 01/22/2013
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Last Update Date | 01/29/2015
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Provider Practice Location Address
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Address Line | 155 N MAIN ST SUITE 102A
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City | COLLIERVILLE
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State | TN
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Zip | 38017-2676
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Country | US
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Telephone | 901-283-4011
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 466
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City | COLLIERVILLE
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State | TN
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Zip | 38027-0466
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Country | US
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Telephone | 901-201-5181
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LETASHA LEWIS
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Credential | FNP
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Telephone | 901-283-4011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 16661
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License Number State | TN
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