Provider Demographics
NPI:1063020469
Name:WADDELL, PATIENCE JARRETT (DNP)
Entity Type:Individual
Prefix:DR
First Name:PATIENCE
Middle Name:JARRETT
Last Name:WADDELL
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:MRS
Other - First Name:PATIENCE
Other - Middle Name:AMY
Other - Last Name:JARRETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4626 SEA ISLE RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-6130
Mailing Address - Country:US
Mailing Address - Phone:901-337-4714
Mailing Address - Fax:
Practice Address - Street 1:880 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-3409
Practice Address - Country:US
Practice Address - Phone:901-545-6969
Practice Address - Fax:901-545-7306
Is Sole Proprietor?:No
Enumeration Date:2020-07-21
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27803363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily