Organization
DROPNSWAP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENDRA BUTLER (CLINICAL DIRECTOR)
(901) 831-0741
Entity
Organization
Contact information
Practice address
4069 LONGHOLLOW DR, MEMPHIS, TN 38128-3017
(901) 831-0741
Mailing address
4069 LONGHOLLOW DR, MEMPHIS, TN 38128-3017
(901) 831-0741
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
APN0000031678
LISENCE
TN
Enumeration date
02/02/2023
Last updated
02/06/2023
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