Provider Demographics
NPI:1336232099
Name:CUNNINGHAM, PATRICIA DUFFY (DNSC, APRN)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:DUFFY
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:DNSC, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1668 FORREST AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38112-4927
Mailing Address - Country:US
Mailing Address - Phone:901-272-0734
Mailing Address - Fax:901-448-4121
Practice Address - Street 1:877 MADISON AVE STE 612
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38163-0001
Practice Address - Country:US
Practice Address - Phone:901-448-6103
Practice Address - Fax:901-448-4121
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000005925363LF0000X, 363LP0808X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Not Answered363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Not Answered364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN14425OtherTLC PIN FNP
TNS92519Medicare UPIN
TN3373444Medicare ID - Type Unspecified