NPI Code Detail JSON Logo

1760767016 NPI number — MODEANNA LEIGH WADE APRN

NPI Number: 1760767016
Health Care Provider/Practitioner: MODEANNA LEIGH WADE APRN

Information about “1760767016” NPI (MODEANNA LEIGH WADE APRN) exists in 1760767016 in HTML format HTML  |  1760767016 in plain Text format TXT  |  1760767016 in PDF (Portable Document Format) PDF  |  1760767016 in an XML format XML  formats.

NPI Number : 1760767016 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1760767016",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WADE",
    "FirstName": "MODEANNA",
    "MiddleName": "LEIGH",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "APRN",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2693 UNION AVENUE EXT STE 100",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MEMPHIS",
    "MailingAddressStateName": "TN",
    "MailingAddressPostalCode": "38112-4403",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "901-726-0843",
    "MailingAddressFaxNumber": "901-708-2699",
    "FirstLinePracticeLocationAddress": "899 HIGHWAY 51 S",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "COVINGTON",
    "PracticeLocationAddressStateName": "TN",
    "PracticeLocationAddressPostalCode": "38019-2568",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "901-244-4646",
    "PracticeLocationAddressFaxNumber": "901-244-4647",
    "EnumerationDate": "10/19/2011",
    "LastUpdateDate": "11/18/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363LF0000X",
        "TaxonomyName": "Family Nurse Practitioner",
        "LicenseNumber": "APN0000016204",
        "LicenseNumberStateCode": "TN",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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