# WADDELL CLINIC PRIMARY CARE & AESTHETICS PLLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1851164560
- **Authorized official:** DONNA WADDELL NP-C (OWNER)
- **Authorized official phone:** (731) 415-8277

## Contact information

- **Practice address:** 9785 HWY 79 S, HENRY, TN 38231
- **Practice address phone:** (731) 423-1450
- **Practice address fax:** (731) 423-1000
- **Mailing address:** 9785 HIGHWAY 79 S, HENRY, TN 38231-3613
- **Mailing address phone:** (731) 243-1450
- **Mailing address fax:** (731) 243-1000

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 11/03/2023
- **Last updated:** 05/31/2024