MEDICARE: ADAM NANAA PMHNP-BC

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	31791	TN

General Provider Information

NPI Number	:	1225767130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADAM NANAA PMHNP-BC

Provider Business Mailing Address
First Line	:	8295 TOURNAMENT DR STE 201
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38125-8913
Country	:	US
Telephone Number	:	901-560-9624
Fax Number	:	901-257-4679

Provider Business Practice Location Address
First Line	:	8295 TOURNAMENT DR STE 201
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38125-8913
Country	:	US
Telephone Number	:	901-560-9624
Fax Number	:	901-257-4679

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

Provider Enumeration Date	:	06/07/2022
Last Update Date	:	09/30/2025

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