Organization
SHD CLINICAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STACY HINES-DOWELL DNP, FNP-BC (CEO/OWNER)
(901) 483-7268
Entity
Organization
Contact information
Practice address
4295 CHILDS DR, MEMPHIS, TN 38116-6909
(901) 483-5791
Mailing address
3856 CHANDLER DR, SOUTHAVEN, MS 38672-7054
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
—
—
251K00000X
Public Health or Welfare Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
261QC1500X
Community Health Clinic/Center
Primary
—
—
261QD0000X
Dental Clinic/Center
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3341212
—
TN
Enumeration date
03/31/2020
Last updated
03/31/2020
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