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General NPI Number Information
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NPI Number | 1710761127
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Entity Type | Organization
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Legal Business Name | FARRIS PEDIATRIC PRIMARY CARE CONCEPT, LLC
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Dates
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Enumeration Date | 08/24/2023
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Last Update Date | 08/24/2023
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Provider Practice Location Address
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Address Line | 4250 FARONIA RD STE 2A
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City | MEMPHIS
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State | TN
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Zip | 38116-6250
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Country | US
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Telephone | 901-236-7707
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Fax |
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Provider Business Mailing Address
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Address Line | 2059 KINGSLEY AVE
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City | MEMPHIS
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State | TN
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Zip | 38127-3933
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Country | US
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Telephone | 901-409-0506
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Fax |
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Authorized Official
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Title or Position | PEDIATRIC NURSE PRACTITIONER
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Name | MRS. JACQUELINE FARRIS
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Credential | PPCNP-BC
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Telephone | 901-409-0506
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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 |
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License Number State |
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