Provider Demographics
NPI:1093132755
Name:BALANCED NATURALLY, LLC
Entity Type:Organization
Organization Name:BALANCED NATURALLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:WOOTTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:901-756-2424
Mailing Address - Street 1:7730 WOLF RIVER BLVD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-1708
Mailing Address - Country:US
Mailing Address - Phone:901-756-2424
Mailing Address - Fax:
Practice Address - Street 1:7730 WOLF RIVER BLVD
Practice Address - Street 2:SUITE 112
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1708
Practice Address - Country:US
Practice Address - Phone:901-756-2424
Practice Address - Fax:901-756-7504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-19
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16459363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty