Provider Demographics
NPI:1184030579
Name:PEOPLES, ARIANNE (PA)
Entity Type:Individual
Prefix:
First Name:ARIANNE
Middle Name:
Last Name:PEOPLES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ARIANNE
Other - Middle Name:
Other - Last Name:KRULISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:2595 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104
Mailing Address - Country:US
Mailing Address - Phone:901-271-6328
Mailing Address - Fax:901-260-8598
Practice Address - Street 1:3124 THOMAS ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38127-6003
Practice Address - Country:US
Practice Address - Phone:901-701-2540
Practice Address - Fax:901-260-8449
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-07
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2484363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ006801Medicaid
TNQ006801Medicaid