Provider Demographics
NPI:1508892241
Name:BIEBERLY, JOHANNA MARIE
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:MARIE
Last Name:BIEBERLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2595 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-5905
Mailing Address - Country:US
Mailing Address - Phone:901-260-8551
Mailing Address - Fax:901-260-8590
Practice Address - Street 1:2861 BROAD AVE
Practice Address - Street 2:CHRIST COMMUNITY HEALTH SERVICES INC
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38112-2903
Practice Address - Country:US
Practice Address - Phone:901-260-8450
Practice Address - Fax:901-260-8590
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN118463163W00000X
TN7712363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1016497Medicaid
LA1016497Medicaid
LA1016497Medicaid
LA3A187F669Medicare PIN