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Organization
WELL CHILD
Active
Organization
WELL CHILD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAKISHA A MCDANIEL (FAMILY NURSE PRACTITIONER)
(870) 739-8631
Entity
Organization
Contact information
Practice address
650 NEW YORK ST, MEMPHIS, TN 38104-5536
(901) 728-5858
(901) 274-5858
Mailing address
112 CABRIOLET CV, MARION, AR 72364-2508
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
17083
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17083
FAMILY NURSE PRACTITIONER
TN
01
—
F0812574
BOARD CERTIFIED
TN
Enumeration date
11/08/2012
Last updated
11/08/2012
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