Provider Demographics
NPI:1275564866
Name:DAVIS-THARPE, VERNESSA LYNN (MD)
Entity Type:Individual
Prefix:
First Name:VERNESSA
Middle Name:LYNN
Last Name:DAVIS-THARPE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 POPLAR AVE BLDG 2
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-4607
Mailing Address - Country:US
Mailing Address - Phone:901-287-5594
Mailing Address - Fax:
Practice Address - Street 1:620 SKYLINE DR FL 3
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3923
Practice Address - Country:US
Practice Address - Phone:866-870-5570
Practice Address - Fax:731-541-8187
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21682208M00000X, 207Q00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3066186Medicaid
4075434OtherBCBS
TN3066180Medicaid
TN3066186Medicaid
4075434OtherBCBS