Provider Demographics
NPI:1255516712
Name:WINFREY, YOLANDA M (NP)
Entity type:Individual
Prefix:
First Name:YOLANDA
Middle Name:M
Last Name:WINFREY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:DEPT 960
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:901-763-0200
Mailing Address - Fax:
Practice Address - Street 1:7460 WOLF RIVER BLVD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1760
Practice Address - Country:US
Practice Address - Phone:901-763-0200
Practice Address - Fax:901-761-4002
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13158363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07558585Medicaid
TN1519976Medicaid
TN4270365OtherBCBST
AR185017758Medicaid
TNP00854029OtherMEDICARE RAILROAD
TN103I500504Medicare UPIN