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General NPI Number Information
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NPI Number | 1710790050
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Entity Type | Individual
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Provider Name | STACEY BONHAM-PALAS DNP, AGACNP
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Gender | Female
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Dates
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Enumeration Date | 01/30/2025
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 6025 WALNUT GROVE RD STE 111
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City | MEMPHIS
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State | TN
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Zip | 38120-2102
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Country | US
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Telephone | 901-271-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 7507 PAR VIEW CV
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City | CORDOVA
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State | TN
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Zip | 38016-8301
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Country | US
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Telephone | 212-203-5855
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 63826
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License Number State | TN
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