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General NPI Number Information
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NPI Number | 1801686894
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Entity Type | Individual
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Provider Name | PORSHA TELLIS
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Gender |
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Dates
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Enumeration Date | 05/12/2025
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Last Update Date | 06/18/2025
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Provider Practice Location Address
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Address Line | 6005 PARK AVE STE 500B
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City | MEMPHIS
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State | TN
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Zip | 38119-5215
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Country | US
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Telephone | 901-683-6925
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Fax | 901-684-1435
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Provider Business Mailing Address
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Address Line | PO BOX 22403
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City | BELFAST
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State | ME
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Zip | 04915-4476
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Country | US
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Telephone | 888-402-7256
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Fax | 888-902-1099
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 38720
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License Number State | TN
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