Individual
BETHANY GRACE MCCLUSKEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
424 CARL MILLER DR, ANTIOCH, TN 37013-4408
(615) 892-9423
Mailing address
424 CARL MILLER DR, ANTIOCH, TN 37013-4408
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
09/07/2021
Last updated
09/07/2021
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