Provider Demographics
NPI:1376830083
Name:MIDCALF, EBONY N (NP)
Entity Type:Individual
Prefix:
First Name:EBONY
Middle Name:N
Last Name:MIDCALF
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6779 SILVER OAK PL
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-4503
Mailing Address - Country:US
Mailing Address - Phone:228-596-4612
Mailing Address - Fax:
Practice Address - Street 1:4323 N JOSEY LN
Practice Address - Street 2:STE 306
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4633
Practice Address - Country:US
Practice Address - Phone:972-939-7011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-01
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1796363LW0102X
MSR886916363LW0102X
TXAP120894363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX330237YL7AMedicare PIN