Provider Demographics
NPI:1639573025
Name:HALKIADES, CHARLOTTE (NP)
Entity type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:
Last Name:HALKIADES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5125 CLEARPOOL PT S
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38141-0253
Mailing Address - Country:US
Mailing Address - Phone:901-921-8338
Mailing Address - Fax:
Practice Address - Street 1:5125 CLEARPOOL PT S
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38141-0253
Practice Address - Country:US
Practice Address - Phone:901-921-8338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18744363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology