Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 28182 | TN |
NPI | 1508466467 |
---|---|
Provider Name | Mr. Ryain Alexander |
First Address | Walnut, MS 38683-8450 |
Second Address | Memphis, TN 38103-2807 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2020 |
Last Update Date | 29/10/2020 |