# BOONES CREEK MEDICAL PLLC

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

## Provider details

- **NPI number:** 1871528976
- **Authorized official:** AMBER F WILKINSON FNP (OWNER/ADMINISTRATOR)
- **Authorized official phone:** (423) 282-0636

## Contact information

- **Practice address:** 2685 BOONES CREEK ROAD, SUITE 104, JOHNSON CITY, TN 37615
- **Practice address phone:** (423) 282-0636
- **Practice address fax:** (423) 282-1990
- **Mailing address:** 1000 W JACKSON BLVD STE 5, JONESBOROUGH, TN 37659-5397
- **Mailing address phone:** (423) 282-1990
- **Mailing address fax:** (423) 282-1990

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/11/2006
- **Last updated:** 02/13/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 3735590 | — | TN |