Provider Demographics
NPI:1225819352
Name:RECTOR, MIKAELE (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:MIKAELE
Middle Name:
Last Name:RECTOR
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6063 MT MORIAH RD EXT
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-2757
Mailing Address - Country:US
Mailing Address - Phone:901-531-8800
Mailing Address - Fax:
Practice Address - Street 1:6625 LENOX PARK DR STE 101
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-4397
Practice Address - Country:US
Practice Address - Phone:901-683-0024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-13
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34864363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics