1679195010 NPI number — CARALYNA NEE

Table of content: CARALYNA NEE (NPI 1679195010)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679195010 NPI number — CARALYNA NEE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEE
Provider First Name:
CARALYNA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679195010
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/16/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6077 PRIMACY PKWY STE 140
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38119-5754
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-259-1600
Provider Business Mailing Address Fax Number:
901-259-1698

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6286 BRIARCREST AVE STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38120-4023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-259-1600
Provider Business Practice Location Address Fax Number:
901-259-1698
Provider Enumeration Date:
05/07/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  668 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: 5126 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AS0400X , with the licence number: 668 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AS0400X , with the licence number: 5126 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)