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Individual

JA'QUAY DANIELLE BRISTER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1030 JEFFERSON AVE, MEMPHIS, TN 38104-2127
(901) 523-8990
Mailing address
2095 EXETER RD STE 80-384, GERMANTOWN, TN 38138-3963
(901) 632-2975
(901) 587-8499

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
26984
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1417420365
NPI
TN
Enumeration date
01/03/2019
Last updated
01/28/2025
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