Provider Demographics
NPI:1437418258
Name:BEAR CREEK MEDICAL CLINIC
Entity Type:Organization
Organization Name:BEAR CREEK MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADULT NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:VAL
Authorized Official - Last Name:NEEL
Authorized Official - Suffix:
Authorized Official - Credentials:ANP
Authorized Official - Phone:931-388-3830
Mailing Address - Street 1:156 BEAR CREEK PIKE
Mailing Address - Street 2:7 A
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-2288
Mailing Address - Country:US
Mailing Address - Phone:931-388-3830
Mailing Address - Fax:931-388-3836
Practice Address - Street 1:156 BEAR CREEK PIKE
Practice Address - Street 2:7 A
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-2288
Practice Address - Country:US
Practice Address - Phone:931-388-3830
Practice Address - Fax:931-388-3836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-14
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000012542363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty