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NPI Code Detail

MEDICARE: MR. CLYDE H ELDER JR. APRN,BC

MEDICARE: MR. CLYDE H ELDER JR. APRN,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
1363LP2300XPrimary Care Nurse PractitionerRN0000048298TN

General Provider Information

NPI Number : 1649288424
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CLYDE H ELDER JR. APRN,BC
Provider Business Mailing Address
First Line : 6785 RICKS RD
Second Line :
City : ARLINGTON
State : TN
Zip : 38002-6907
Country : US
Telephone Number : 901-873-3923
Fax Number : 901-261-4511
Provider Business Practice Location Address
First Line : 3461 AUSTIN PEAY HWY
Second Line :
City : MEMPHIS
State : TN
Zip : 38128-3801
Country : US
Telephone Number : 901-261-4500
Fax Number : 901-261-4511
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2006
Last Update Date : 07/08/2007

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