Individual
DR. NANETTA R. WALLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
5366 ESTATE OFFICE DRIVE, SUITE 3, MEMPHIS, TN 38119-0611
(901) 508-5257
(901) 388-1995
Mailing address
5366 ESTATE OFFICE DRIVE, SUITE 3, MEMPHIS, TN 38119-0611
(901) 508-5257
(901) 388-1995
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
P001065
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07454015
—
MS
05
—
3387193
—
TN
01
—
50159
BCBS OF TN
TN
Enumeration date
11/08/2006
Last updated
10/14/2020
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