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General NPI Number Information
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NPI Number | 1881300663
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Entity Type | Organization
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Legal Business Name | MEMPHIS COMMUNITY HEALTH & WELLNESS CLINIC, PLLC
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Dates
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Enumeration Date | 01/25/2023
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Last Update Date | 10/23/2024
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Provider Practice Location Address
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Address Line | 8295 TOURNAMENT DR STE 150
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City | MEMPHIS
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State | TN
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Zip | 38125-8900
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Country | US
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Telephone | 901-763-8372
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Fax |
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Provider Business Mailing Address
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Address Line | 1910 MADISON AVE # 2974
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City | MEMPHIS
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State | TN
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Zip | 38104-2620
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Country | US
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Telephone | 901-201-4614
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER/ FNP
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Name | MS. ALISHA DANIELLE KIMBER
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Credential | FNP
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Telephone | 901-201-4614
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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