Provider Demographics
NPI:1346513462
Name:COLLIE, ENID BARR (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ENID
Middle Name:BARR
Last Name:COLLIE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ENID
Other - Middle Name:MARIJEAN
Other - Last Name:BARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18700 HIGHWAY 64
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38068-3623
Mailing Address - Country:US
Mailing Address - Phone:901-465-6327
Mailing Address - Fax:901-465-6327
Practice Address - Street 1:3960 NEW COVINGTON PIKE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-2504
Practice Address - Country:US
Practice Address - Phone:901-516-5211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16363363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily