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General NPI Number Information
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NPI Number | 1669141669
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Entity Type | Individual
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Provider Name | KRISTI SHERIDAN
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Gender | Female
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Dates
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Enumeration Date | 09/13/2021
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Last Update Date | 06/18/2024
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Provider Practice Location Address
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Address Line | 262 DANNY THOMAS PL
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City | MEMPHIS
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State | TN
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Zip | 38105-3678
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Country | US
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Telephone | 15-953-3009
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Fax |
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Provider Business Mailing Address
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Address Line | 4701 FLAMINGO RD
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City | MEMPHIS
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State | TN
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Zip | 38117-6111
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Country | US
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Telephone |
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 35648
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 163WP0200X
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Taxonomy Name | Pediatric Registered Nurse
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License Number | RN259102
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License Number State | GA
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