MEDICARE: CHERYL LYNNE WHITE FNP

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	810080	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	:	1760480040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL LYNNE WHITE FNP

Provider Business Mailing Address
First Line	:	3477 DAWNRIDGE DR
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38118-8136
Country	:	US
Telephone Number	:	901-376-9038
Fax Number	:	901-367-9038

Provider Business Practice Location Address
First Line	:	3477 DAWNRIDGE DR
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38118-8136
Country	:	US
Telephone Number	:	901-281-9036
Fax Number	:	901-367-9038

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	01/04/2008

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