MEDICARE: VALERIE M WATTERS-BURKE 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	6576	TN

General Provider Information

NPI Number	:	1922055631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALERIE M WATTERS-BURKE FNP

Provider Business Mailing Address
First Line	:	2939 COUNTRY PLACE DR E
Second Line	:
City	:	COLLIERVILLE
State	:	TN
Zip	:	38017-8902
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 W POPLAR AVE
Second Line	:
City	:	COLLIERVILLE
State	:	TN
Zip	:	38017-0601
Country	:	US
Telephone Number	:	901-861-9000
Fax Number	:

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

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	02/19/2023

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