Provider Demographics
NPI:1568690741
Name:DUCKWORTH, NANCY H (MD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:H
Last Name:DUCKWORTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:539 LEMASTER ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-5133
Mailing Address - Country:US
Mailing Address - Phone:901-274-6688
Mailing Address - Fax:
Practice Address - Street 1:539 LEMASTER ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-5133
Practice Address - Country:US
Practice Address - Phone:901-274-6688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-26
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN69112084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMO201614708Medicaid
MS18549Medicaid
ARAR115593001Medicaid
TNTN3159246Medicaid
MOMO201614708Medicaid