Organization · NPI-2

Community Transition Nurse Care Manager, LLC

Nurse Practitioner, Primary Care · Memphis, TN

NPI number1659752103

StatusActive

Last updated in NPPESAug 4, 2022

Details

NPI: 1659752103
Entity type: Organization (NPI-2)
Legal business name: Community Transition Nurse Care Manager, LLC
Organization subpart: No
Enumeration date: Jun 10, 2015
Certification date: Aug 4, 2022
Last updated: Aug 4, 2022

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
363LP2300X	Nurse Practitioner, Primary Care	–	–	Yes
363L00000X	Nurse Practitioner	–	–
163WC0400X	Registered Nurse, Case Management	–	–
251B00000X	Case Management	–	–
251E00000X	Home Health	–	–
251J00000X	Nursing Care	1000000016409	TN
261QP2300X	Clinic/Center, Primary Care	–	–

Other names

Shephard Primary Care (Doing Business As)

Practice location

3238 Players Club Cir Ste 58&59
Memphis, TN 38125-8843

Phone 901-869-5744 · Fax 901-794-4128

Mailing address

4405 Timber Jump
Memphis, TN 38141-7395

Phone 901-550-1486

Authorized official

Addie Marchant
Owner/Ceo
9015501486

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