MEDICARE: LATRINA NOVELLE BLAKEMORE FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	14207	TN
2	363LF0000X	Family Nurse Practitioner	APN0000014207	TN

General Provider Information

NPI Number	:	1134356892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATRINA NOVELLE BLAKEMORE FNP

Provider Business Mailing Address
First Line	:	1509 UNION AVE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38104-3726
Country	:	US
Telephone Number	:	901-272-0806
Fax Number	:	901-729-2428

Provider Business Practice Location Address
First Line	:	3904 GALLATIN PIKE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37216-2406
Country	:	US
Telephone Number	:	615-227-3000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2009
Last Update Date	:	06/18/2025

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