Provider Demographics
NPI:1093282659
Name:GUY, YVETTE
Entity type:Individual
Prefix:
First Name:YVETTE
Middle Name:
Last Name:GUY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5089 BOWIE RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38109-6047
Mailing Address - Country:US
Mailing Address - Phone:901-550-2290
Mailing Address - Fax:901-421-8864
Practice Address - Street 1:5089 BOWIE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38109-6047
Practice Address - Country:US
Practice Address - Phone:901-550-2290
Practice Address - Fax:901-421-8864
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-31
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN115003290343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4127414465Medicaid