MEDICARE: KATHERINE EVANS ELSENRATH APRN

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	363L00000X	Nurse Practitioner	25067	TN

General Provider Information

NPI Number	:	1760048508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE EVANS ELSENRATH APRN

Provider Business Mailing Address
First Line	:	1215 POPLAR AVE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38104-7241
Country	:	US
Telephone Number	:	901-523-7781
Fax Number	:

Provider Business Practice Location Address
First Line	:	1215 POPLAR AVE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38104-7241
Country	:	US
Telephone Number	:	901-523-7781
Fax Number	:

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

Provider Enumeration Date	:	05/17/2019
Last Update Date	:	05/17/2019

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