Provider Demographics
NPI:1811666712
Name:POWER, JERI
Entity type:Individual
Prefix:
First Name:JERI
Middle Name:
Last Name:POWER
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 1:3535 POPLAR AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-6077
Mailing Address - Country:US
Mailing Address - Phone:501-339-8661
Mailing Address - Fax:
Practice Address - Street 1:853 JEFFERSON AVE # E206
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-2804
Practice Address - Country:US
Practice Address - Phone:901-448-6728
Practice Address - Fax:901-302-2495
Is Sole Proprietor?:No
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30093363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN30093OtherSTATE OF TN LICENSE