Provider Demographics
NPI:1093845695
Name:THE CLINIC, PLLC
Entity Type:Organization
Organization Name:THE CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SYBLE
Authorized Official - Middle Name:S
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:731-286-0490
Mailing Address - Street 1:520 E PARKVIEW ST
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-3114
Mailing Address - Country:US
Mailing Address - Phone:731-286-0490
Mailing Address - Fax:731-286-0469
Practice Address - Street 1:520 E PARKVIEW ST
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-3114
Practice Address - Country:US
Practice Address - Phone:731-286-0490
Practice Address - Fax:731-286-0469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN 5212363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3499880Medicaid
TNDG3551OtherRAILROAD MEDICARE
TNDG3551OtherRAILROAD MEDICARE