Individual
MRS. LINDA FAY WOOTEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2259 SPRING PLACE RD SE, CLEVELAND, TN 37323
(423) 559-8176
(423) 559-9699
Mailing address
2259 SPRING PLACE RD SE, CLEVELAND, TN 37323
(423) 559-8176
(423) 559-9699
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
0066621
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4108705
BLUE CARE TENN CARE SELEC
TN
05
—
T000174
—
TN
Enumeration date
11/30/2006
Last updated
07/08/2007
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