Basic Information
| Provider Information | |||||||||
| NPI: | 1184643991 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUMBLE | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | ANNETTE | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9830 REDWOOD RD | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381202146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9018294999 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1030 JEFFERSON AVE | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381042127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9015238990 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 04/17/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 5593 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | A810154 | MS | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | A01900 | AR | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.