Provider Demographics
NPI:1770349011
Name:FORD, PATRICIA RUSSELL (FNP)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:RUSSELL
Last Name:FORD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:360 E EH CRUMP BLVD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38126-5394
Mailing Address - Country:US
Mailing Address - Phone:901-261-2000
Mailing Address - Fax:901-432-0521
Practice Address - Street 1:360 E EH CRUMP BLVD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38126-5394
Practice Address - Country:US
Practice Address - Phone:901-261-2000
Practice Address - Fax:901-432-0512
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35773363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner