Basic Information
| Provider Information | |||||||||
| NPI: | 1154351278 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRESS | ||||||||
| FirstName: | FAWN | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 350 N HUMPHREYS BLVD | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381202177 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012270497 | ||||||||
| FaxNumber: | 9012270499 | ||||||||
| Practice Location | |||||||||
| Address1: | 7424 US HIGHWAY 64 | ||||||||
| Address2: | SUITE 111 | ||||||||
| City: | BARTLETT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381333986 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9013857817 | ||||||||
| FaxNumber: | 9013832150 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/04/2006 | ||||||||
| LastUpdateDate: | 06/09/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 81-0029 | MS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 09684770 | 05 | MS | MEDICAID | 39951 | 01 | TN | TLC | OTHER | 4146160 | 01 | TN | BLUE CROSS BLUE SHIELD | OTHER |