Provider Demographics
NPI:1225100282
Name:HOCKETT, RAE (FNP)
Entity Type:Individual
Prefix:
First Name:RAE
Middle Name:
Last Name:HOCKETT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:RAE
Other - Middle Name:
Other - Last Name:TURNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P O BOX 1000 DEPT 960
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:901-763-0200
Mailing Address - Fax:901-260-1704
Practice Address - Street 1:7655 POPLAR AVE STE 350
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-4933
Practice Address - Country:US
Practice Address - Phone:901-761-2470
Practice Address - Fax:901-767-4898
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11992363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3341349Medicaid
TN3341349Medicare PIN