Provider Demographics
NPI:1326487554
Name:KALEIDOSCOPE FAMILY HEALTH, INC.
Entity Type:Organization
Organization Name:KALEIDOSCOPE FAMILY HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BRICKNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-545-9250
Mailing Address - Street 1:4900 NEW HIGHWAY 68
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37354-2142
Mailing Address - Country:US
Mailing Address - Phone:423-545-9250
Mailing Address - Fax:423-545-9631
Practice Address - Street 1:4900 NEW HIGHWAY 68
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37354-2142
Practice Address - Country:US
Practice Address - Phone:423-545-9250
Practice Address - Fax:423-545-9631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty