MEDICARE: JEFFREY E BANHAM NP

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	363LF0000X	Family Nurse Practitioner	22959	TN

General Provider Information

NPI Number	:	1477078962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY E BANHAM NP

Provider Business Mailing Address
First Line	:	1211 UNION AVE STE 330
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38104-6655
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2589 APPLING RD STE 101
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38133-5099
Country	:	US
Telephone Number	:	901-752-2300
Fax Number	:	901-249-8871

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

Provider Enumeration Date	:	08/07/2017
Last Update Date	:	04/22/2025

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Directions to “ JEFFREY E BANHAM NP” Practice Location

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