Provider Demographics
NPI:1649288424
Name:ELDER, CLYDE H JR (APRN,BC)
Entity type:Individual
Prefix:MR
First Name:CLYDE
Middle Name:H
Last Name:ELDER
Suffix:JR
Gender:M
Credentials:APRN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6785 RICKS RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38002-6907
Mailing Address - Country:US
Mailing Address - Phone:901-873-3923
Mailing Address - Fax:901-261-4511
Practice Address - Street 1:3461 AUSTIN PEAY HWY
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-3801
Practice Address - Country:US
Practice Address - Phone:901-261-4500
Practice Address - Fax:901-261-4511
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNRN0000048298363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care