Provider Demographics
NPI:1972903375
Name:WOMBLE HEALTHCARE
Entity Type:Organization
Organization Name:WOMBLE HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTIONER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:WOMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-BC
Authorized Official - Phone:931-685-9277
Mailing Address - Street 1:208 LANE PKWY
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160-3109
Mailing Address - Country:US
Mailing Address - Phone:931-685-9277
Mailing Address - Fax:931-685-9244
Practice Address - Street 1:208 LANE PKWY
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-3109
Practice Address - Country:US
Practice Address - Phone:931-685-9277
Practice Address - Fax:931-685-9244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10762363LF0000X
TN18403363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty