| NPI | 1659716934 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN T HICKS Owner, Nurse Practitioner 865-212-2211 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 1041C0700X Social Worker Clinical |
| 207Q00000X Family Medicine (Licence: TN 40307) | |
| 302F00000X Exclusive Provider Organization (Licence: TN 40307) | |
| 363LF0000X Nurse Practitioner Family | |
| Enumeration Date | 2013-05-01 |
| Last Update Date | 2024-06-04 |