Provider Demographics
NPI:1407194269
Name:MCGHEE, MIRANDA FAITH KING (APN)
Entity Type:Individual
Prefix:MRS
First Name:MIRANDA
Middle Name:FAITH KING
Last Name:MCGHEE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1169 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-7217
Mailing Address - Country:US
Mailing Address - Phone:901-452-1880
Mailing Address - Fax:901-725-5768
Practice Address - Street 1:1169 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-7217
Practice Address - Country:US
Practice Address - Phone:901-452-1880
Practice Address - Fax:901-725-5768
Is Sole Proprietor?:No
Enumeration Date:2013-01-29
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17323363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ000475Medicaid