1982226395 NPI number — VIRGINIA ST. MARTHA ADAMS APRN

Table of content: (NPI 1053919662)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982226395 NPI number — VIRGINIA ST. MARTHA ADAMS APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADAMS
Provider First Name:
VIRGINIA
Provider Middle Name:
ST. MARTHA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FEEHERY
Provider Other First Name:
VIRGINIA
Provider Other Middle Name:
ST. MARTHA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1982226395
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/14/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
756 RIDGE LAKE BLVD
Provider Second Line Business Mailing Address:
STE 228
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38120-9445
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-522-6910
Provider Business Mailing Address Fax Number:
901-522-6911

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
756 RIDGE LAKE BLVD STE 228
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:
38120-9445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-522-6910
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/08/2020

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: 363LF0000X , with the licence number:  27538 , 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)





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