Provider Demographics
NPI:1922546787
Name:MT. JULIET FAMILY CARE & WALK-IN CLINIC, LLC
Entity Type:Organization
Organization Name:MT. JULIET FAMILY CARE & WALK-IN CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:CASSIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WALDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:615-754-2828
Mailing Address - Street 1:637 ATLANTA DR
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-1536
Mailing Address - Country:US
Mailing Address - Phone:615-957-8896
Mailing Address - Fax:
Practice Address - Street 1:754 N MOUNT JULIET RD
Practice Address - Street 2:
Practice Address - City:MT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-3950
Practice Address - Country:US
Practice Address - Phone:615-754-2828
Practice Address - Fax:615-754-2818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21959363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty