Provider Demographics
NPI:1073050951
Name:HWV PRIMARY CARE CLINIC, PLLC
Entity Type:Organization
Organization Name:HWV PRIMARY CARE CLINIC, PLLC
Other - Org Name:HEALTH AND WELLNESS AT THE VILLAGE, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/APRN
Authorized Official - Prefix:MS
Authorized Official - First Name:DERESSA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:731-326-2503
Mailing Address - Street 1:PO BOX 871
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37116-0871
Mailing Address - Country:US
Mailing Address - Phone:615-357-0139
Mailing Address - Fax:615-357-0257
Practice Address - Street 1:3139 LEBANON PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-2314
Practice Address - Country:US
Practice Address - Phone:615-357-0139
Practice Address - Fax:615-357-0257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-30
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ041062Medicaid
TNQ041043Medicaid