Provider Demographics
NPI:1366763435
Name:MUSE, KATOSHA ANDRA (MD)
Entity type:Individual
Prefix:DR
First Name:KATOSHA
Middle Name:ANDRA
Last Name:MUSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6005 PARK AVE STE 501
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5215
Mailing Address - Country:US
Mailing Address - Phone:901-590-2565
Mailing Address - Fax:901-435-6588
Practice Address - Street 1:6005 PARK AVE STE 501
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119
Practice Address - Country:US
Practice Address - Phone:901-590-2565
Practice Address - Fax:901-435-6588
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-11
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000050313174400000X
TN50313207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine