Provider Demographics
NPI:1184107302
Name:FAITH FAMILY WELLNESS CLINIC, PLLC
Entity type:Organization
Organization Name:FAITH FAMILY WELLNESS CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCBAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-492-5290
Mailing Address - Street 1:2012 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160-2022
Mailing Address - Country:US
Mailing Address - Phone:931-492-5290
Mailing Address - Fax:931-492-5292
Practice Address - Street 1:2012 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-2022
Practice Address - Country:US
Practice Address - Phone:931-492-5290
Practice Address - Fax:931-492-5292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-13
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty