Organization
BLUEGRASS LEGACY HEALTHCARE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ABIGAIL JOAN EUBANK APN (NURSE PRACTITIONER)
(615) 826-2265
Entity
Organization
Contact information
Practice address
105 GLEN OAK BLVD STE 202, HENDERSONVILLE, TN 37075-3058
(615) 826-2265
(615) 826-4616
Mailing address
105 GLEN OAK BLVD STE 202, HENDERSONVILLE, TN 37075-3058
(615) 826-2265
(615) 826-4616
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4112769
BCBST
TN
Enumeration date
03/04/2021
Last updated
06/13/2024
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