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Individual

ALLYN NOELLE FARMER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
80 HUMPHREYS CENTER DR STE 100, MEMPHIS, TN 38120-2352
(901) 761-9030
(901) 761-9591
Mailing address
PO BOX 1000 DEPT 245, MEMPHIS, TN 38148-0001
(901) 761-9030
(901) 761-9591

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA 814
AL
363AS0400X
Surgical Physician Assistant
Primary
10001395A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000779998
ANTHEM PROVIDER NUMBER
IN
01
2555
TN MEDICAL LICENSE
TN
01
PA 814
STATE BOARD OF MEDICAL EXAMINERS
AL
Enumeration date
02/09/2012
Last updated
09/10/2014
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