Provider Demographics
NPI:1679107189
Name:WEATHERSPOON NOLEN, YOLUNDA (FNP-BC)
Entity type:Individual
Prefix:
First Name:YOLUNDA
Middle Name:
Last Name:WEATHERSPOON NOLEN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4913 RALEIGH COMMON DR STE 201
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128-2485
Mailing Address - Country:US
Mailing Address - Phone:901-878-3366
Mailing Address - Fax:
Practice Address - Street 1:4913 RALEIGH COMMON DR STE 201
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-2485
Practice Address - Country:US
Practice Address - Phone:901-878-3366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26133363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner