Provider Demographics
NPI:1962666214
Name:MYRICK, ELIZABETH GRIFFITH (CRNA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:GRIFFITH
Last Name:MYRICK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:MCDONALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 171306
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38187-1306
Mailing Address - Country:US
Mailing Address - Phone:901-725-5846
Mailing Address - Fax:901-726-4827
Practice Address - Street 1:1755 KIRBY PKWY STE 330
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-4398
Practice Address - Country:US
Practice Address - Phone:901-725-5846
Practice Address - Fax:901-726-4827
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN123088163WC0200X
ARC02723CRNA367500000X
TN16958367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine