Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | E-10471 | AR |
Y | 2080P0201X | Pediatric Allergist | 61070 | TN |
NPI | 1376962902 |
---|---|
Provider Name | Annette Carlisle |
First Address | Memphis, TN 38105-4607 |
Second Address | Memphis, TN 38105-4625 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2014 |
Last Update Date | 17/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
08808809 | (05) | MS |
220713001 | (05) | AR |
Q043210 | (05) | TN |