Organization
FAMILY AND PEDIATRIC CARE CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DONNA WEST (OFFICE MANAGER)
(423) 569-2754
Entity
Organization
Contact information
Practice address
19067 ALBERTA ST, ONEIDA, TN 37841-6002
(423) 569-2754
(423) 569-2756
Mailing address
PO BOX 681, SYLVA, NC 28779-0681
(828) 339-7253
(828) 586-8209
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
0000016521
TN
363LF0000X
Family Nurse Practitioner
Primary
0000020552
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103G741696
TN MEDICARE
TN
01
—
6080615
BCBS TN
TN
05
—
Q025132
—
TN
Enumeration date
07/05/2016
Last updated
06/19/2019
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