Provider Demographics
NPI:1982834552
Name:CORNERSTONE FAMILY PRACTICE, INC.
Entity Type:Organization
Organization Name:CORNERSTONE FAMILY PRACTICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT- NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:HENSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:865-262-9095
Mailing Address - Street 1:3371 BLUE SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:STRAWBERRY PLAINS
Mailing Address - State:TN
Mailing Address - Zip Code:37871-3848
Mailing Address - Country:US
Mailing Address - Phone:865-617-5081
Mailing Address - Fax:865-465-9098
Practice Address - Street 1:1171 W HIGHWAY 11E
Practice Address - Street 2:
Practice Address - City:NEW MARKET
Practice Address - State:TN
Practice Address - Zip Code:37820-4106
Practice Address - Country:US
Practice Address - Phone:865-262-9095
Practice Address - Fax:865-262-9098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-17
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12228261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care