Basic Information
Provider Information
NPI: 1285792648
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ADAIR
FirstName: LORETTA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: FNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3960 KNIGHT ARNOLD RD
Address2: SUITE 102
City: MEMPHIS
State: TN
PostalCode: 381183001
CountryCode: US
TelephoneNumber: 9013696000
FaxNumber: 9013696001
Practice Location
Address1: 3960 KNIGHT ARNOLD RD
Address2: SUITE 102
City: MEMPHIS
State: TN
PostalCode: 381183035
CountryCode: US
TelephoneNumber: 9013696000
FaxNumber: 9013696001
Other Information
ProviderEnumerationDate: 12/05/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XAPN5991TNY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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