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NPI Code Detail

MEDICARE: DR. JENNIFER DAYLE MINK M.D.

MEDICARE: DR. JENNIFER DAYLE MINK M.D.
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
1208000000XPediatrics Physician39459TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1598759359
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JENNIFER DAYLE MINK M.D.
Provider Business Mailing Address
First Line : 2860 COVINGTON PIKE
Second Line :
City : MEMPHIS
State : TN
Zip : 38128-8090
Country : US
Telephone Number : 901-252-6034
Fax Number : 901-252-6048
Provider Business Practice Location Address
First Line : 6625 LENOX PARK DR STE 101
Second Line :
City : MEMPHIS
State : TN
Zip : 38115-4397
Country : US
Telephone Number : 901-683-0024
Fax Number : 901-683-0086
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/08/2005
Last Update Date : 01/22/2025

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