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Organization

HEALTHY LIFE CLINIC, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. GARY R. BICKFORD FNP-BC (OWNER)
(865) 247-6340
Entity
Organization

Contact information

Practice address
110 PERIMETER PARK RD., SUITE G, KNOXVILLE, TN 37922-2200
(865) 247-6340
(865) 951-2617
Mailing address
110 PERIMETER PARK RD., SUITE G, KNOXVILLE, TN 37922-2200
(865) 247-6340
(865) 951-2617

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
APN0000012264
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1517282
TN
Enumeration date
07/21/2009
Last updated
01/27/2012
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