Provider Demographics
NPI:1225471576
Name:FORD, ESSIE MARIE (RN)
Entity Type:Individual
Prefix:MS
First Name:ESSIE
Middle Name:MARIE
Last Name:FORD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:ESSIE
Other - Middle Name:MARIE
Other - Last Name:FORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:4523 FAIRWIND CV
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-3562
Mailing Address - Country:US
Mailing Address - Phone:901-292-5967
Mailing Address - Fax:
Practice Address - Street 1:3540 SUMMER AVE
Practice Address - Street 2:SUITE 406
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38122-3600
Practice Address - Country:US
Practice Address - Phone:901-320-7997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000099620372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion