Provider Demographics
NPI:1306133848
Name:GRESHAM, FLOTYL K (MSN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:FLOTYL
Middle Name:K
Last Name:GRESHAM
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8071 WINCHESTER RD STE 3
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-8206
Mailing Address - Country:US
Mailing Address - Phone:901-756-6056
Mailing Address - Fax:
Practice Address - Street 1:8071 WINCHESTER RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-8206
Practice Address - Country:US
Practice Address - Phone:901-756-6056
Practice Address - Fax:901-624-0702
Is Sole Proprietor?:No
Enumeration Date:2011-07-05
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSA810422363LF0000X
TNAPN0000015939363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily