Organization
HEALTHWISE 360 LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTIE GUTGSELL (OWNER/OPERATOR)
(731) 736-4300
Entity
Organization
Contact information
Practice address
8 STONEBRIDGE BLVD STE M, JACKSON, TN 38305-2178
(731) 267-2836
Mailing address
617 BOLEN AVE, HENDERSON, TN 38340-1521
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q027339
—
TN
Enumeration date
03/16/2017
Last updated
09/09/2019
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