Provider Demographics
NPI:1043364201
Name:CHEATHAM CARPENTER, TERRELL (FNP)
Entity Type:Individual
Prefix:MRS
First Name:TERRELL
Middle Name:
Last Name:CHEATHAM CARPENTER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:TERRELL
Other - Middle Name:C
Other - Last Name:CARPENTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1251 WESLEY DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38116-6442
Mailing Address - Country:US
Mailing Address - Phone:901-348-6426
Mailing Address - Fax:901-207-5178
Practice Address - Street 1:1251 WESLEY DRIVE
Practice Address - Street 2:SUITE 104
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116
Practice Address - Country:US
Practice Address - Phone:901-348-6426
Practice Address - Fax:901-207-5178
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN6284363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ015961Medicaid