Organization
HOMETOWN FAMILY CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WANDA FAYE KEAGLE MSN, FNP (OWNER/PRACTITIONER)
(931) 854-0050
Entity
Organization
Contact information
Practice address
675 B SOUTH JEFFERSON AVENUE, COOKEVILLE, TN 38501-0950
(931) 854-0050
(931) 854-0411
Mailing address
675 B SOUTH JEFFERSON AVENUE, COOKEVILLE, TN 38501-0950
(931) 854-0050
(931) 854-0411
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
ANP 16167
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1740565282
INDIVIDUAL NPI
—
01
—
ANP 16167
STATE LICENSE
TN
Enumeration date
10/14/2013
Last updated
03/06/2014
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