# FARRIS PEDIATRIC PRIMARY CARE CONCEPT, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710761127
- **Authorized official:** MRS. JACQUELINE FARRIS PPCNP-BC (PEDIATRIC NURSE PRACTITIONER)
- **Authorized official phone:** (901) 409-0506

## Contact information

- **Practice address:** 4250 FARONIA RD STE 2A, MEMPHIS, TN 38116-6250
- **Practice address phone:** (901) 236-7707
- **Mailing address:** 2059 KINGSLEY AVE, MEMPHIS, TN 38127-3933
- **Mailing address phone:** (901) 409-0506

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0200X | Pediatric Nurse Practitioner | — | NULL | Yes |
| 363LP0200X | Pediatric Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 08/24/2023
- **Last updated:** 08/24/2023