Individual
BREYOCHA DEWALT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1211 UNION AVE STE 965, MEMPHIS, TN 38104-6638
(901) 435-8550
(901) 478-0781
Mailing address
PO BOX 1000, DEPT 960, MEMPHIS, TN 38148-0001
(901) 758-9900
(901) 752-2335
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
0000223825
TN
363LA2100X
Acute Care Nurse Practitioner
Primary
34590
TN
Other
Enumeration date
08/30/2023
Last updated
09/20/2023
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