Provider Demographics
NPI:1255340808
Name:MCCORMICK, PAULA F (FNP)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:F
Last Name:MCCORMICK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 UNION AVE
Mailing Address - Street 2:ALLIANCE HEALTH CARE SERVICES
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104
Mailing Address - Country:US
Mailing Address - Phone:901-369-1480
Mailing Address - Fax:901-369-1452
Practice Address - Street 1:5210 POPLAR AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3515
Practice Address - Country:US
Practice Address - Phone:901-685-3490
Practice Address - Fax:901-685-3499
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN81186163W00000X
TN0000006361363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3349904Medicaid
TN3349905OtherMEDICARE PROVIDER NUMBER
TN3349905Medicare PIN
TN3349905OtherMEDICARE PROVIDER NUMBER