Organization
CONVIENENT CARE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KELLY MICHELLE MCCALLUM FNP (SOLE PROPRIETOR)
(731) 445-9406
Entity
Organization
Contact information
Practice address
2490 PARR AVE STE 3, DYERSBURG, TN 38024-2029
(731) 286-8007
Mailing address
2490 PARR AVE, SUITE 3, DYERSBURG, TN 38024-2029
(731) 286-8007
(731) 286-8019
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
13555
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q008468
—
TN
Enumeration date
11/21/2011
Last updated
10/15/2014
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