Provider Demographics
NPI:1376201244
Name:TAHA, YASMEAN MAHER (PA-C)
Entity Type:Individual
Prefix:
First Name:YASMEAN
Middle Name:MAHER
Last Name:TAHA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9301 POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-7906
Mailing Address - Country:US
Mailing Address - Phone:901-762-1531
Mailing Address - Fax:901-762-1532
Practice Address - Street 1:9301 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-7906
Practice Address - Country:US
Practice Address - Phone:901-762-1531
Practice Address - Fax:901-762-1532
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-07
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4790363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty