Organization
METHODIST LE BONHEUR COMMUNITY OUTREACH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAM DENISE BURNETT (MANAGER OF OPERATIONS)
(731) 984-9963
Entity
Organization
Contact information
Practice address
77 STONEBRIDGE BLVD, JACKSON, TN 38305-2165
(901) 287-5961
Mailing address
1535 VANN DR, JACKSON, TN 38305-2095
(731) 499-0977
(731) 499-9939
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
363LC1500X
Community Health Nurse Practitioner
—
—
Other
Enumeration date
09/06/2012
Last updated
08/19/2019
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