Provider Demographics
NPI:1548615552
Name:PRIMARY CARE PLUS
Entity Type:Organization
Organization Name:PRIMARY CARE PLUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHARINE
Authorized Official - Middle Name:
Authorized Official - Last Name:VACHON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:931-802-6058
Mailing Address - Street 1:291 CLEAR SKY CT
Mailing Address - Street 2:B
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-5951
Mailing Address - Country:US
Mailing Address - Phone:931-802-6058
Mailing Address - Fax:931-802-6059
Practice Address - Street 1:291 CLEAR SKY CT
Practice Address - Street 2:B
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-5951
Practice Address - Country:US
Practice Address - Phone:931-802-6058
Practice Address - Fax:931-802-6059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11796363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1517918Medicaid
TN1517918Medicaid