Provider Demographics
NPI:1265030175
Name:ALLRED, CLIFTON MCRAE (APRN)
Entity Type:Individual
Prefix:
First Name:CLIFTON
Middle Name:MCRAE
Last Name:ALLRED
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:CLIFF
Other - Middle Name:MCRAE
Other - Last Name:ALLRED
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6005 PARK AVE STE 630B
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5226
Mailing Address - Country:US
Mailing Address - Phone:901-767-1136
Mailing Address - Fax:
Practice Address - Street 1:6005 PARK AVE STE 630B
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5226
Practice Address - Country:US
Practice Address - Phone:901-767-1136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN226420163WP0808X
TN29014363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health