MEDICARE: SHIRLEY SPILLER-JOHNSON ADMINISTRATOR/OPERAT

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	164W00000X	Licensed Practical Nurse	0000000565	TN
2	372500000X	Chore Provider	0000000565	TN
3	372600000X	Adult Companion	0000000565	TN
4	3747A0650X	Attendant Care Provider	0000000565	TN
5	3747P1801X	Personal Care Attendant	0000000565	TN
6	376G00000X	Nursing Home Administrator	0000000565	TN

Other Identifiers

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

General Provider Information

NPI Number	:	1740678960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIRLEY SPILLER-JOHNSON ADMINISTRATOR/OPERAT

Provider Business Mailing Address
First Line	:	2051 MONTREAT DR
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38134-6613
Country	:	US
Telephone Number	:	901-598-7437
Fax Number	:	901-388-7366

Provider Business Practice Location Address
First Line	:	2051 MONTREAT DR
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38134-6613
Country	:	US
Telephone Number	:	901-598-7437
Fax Number	:	901-388-7366

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

Provider Enumeration Date	:	12/23/2014
Last Update Date	:	12/23/2014

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