Provider Demographics
NPI:1376538561
Name:FREEMAN, DONNA GATELEY (FNP-BC)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:GATELEY
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:DEPT 978
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:901-525-3086
Mailing Address - Fax:901-525-0844
Practice Address - Street 1:6401 POPLAR AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-4823
Practice Address - Country:US
Practice Address - Phone:901-525-3086
Practice Address - Fax:901-525-0844
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6362363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3346640Medicaid
TN3346640Medicaid
TNS68066Medicare UPIN