Provider Demographics
NPI:1245805159
Name:MEDICINE WOMEN LLC
Entity Type:Organization
Organization Name:MEDICINE WOMEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:UPCHURCH - HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:865-268-2185
Mailing Address - Street 1:PO BOX 808
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:37763-0808
Mailing Address - Country:US
Mailing Address - Phone:865-234-8189
Mailing Address - Fax:865-674-5180
Practice Address - Street 1:107 WHEELERTOWN AVE
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37367-5246
Practice Address - Country:US
Practice Address - Phone:865-268-2180
Practice Address - Fax:865-246-6570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute CareGroup - Single Specialty