Individual
TERRI WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1056 E RAINES RD, MEMPHIS, TN 38116-6337
(901) 300-5777
(901) 422-6092
Mailing address
1056 E RAINES RD, MEMPHIS, TN 38116-6337
(901) 300-5777
(901) 422-6092
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
21186
TN
363L00000X
Nurse Practitioner
904130
MS
363LF0000X
Family Nurse Practitioner
21186
TN
Other
Enumeration date
04/28/2016
Last updated
07/18/2025
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