Provider Demographics
NPI:1801221239
Name:MT VIEW FAMILY CARE, PLLC
Entity Type:Organization
Organization Name:MT VIEW FAMILY CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:LAWANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCKISSACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-482-4879
Mailing Address - Street 1:10541 CEDAR GROVE RD
Mailing Address - Street 2:STE. 130
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-8123
Mailing Address - Country:US
Mailing Address - Phone:615-727-2434
Mailing Address - Fax:
Practice Address - Street 1:10541 CEDAR GROVE RD
Practice Address - Street 2:STE. 130
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-8123
Practice Address - Country:US
Practice Address - Phone:615-727-2434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15063363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty