Provider Demographics
NPI:1457932691
Name:CORE ESSENTIALS PRIMARY CARE CLINIC LLC
Entity Type:Organization
Organization Name:CORE ESSENTIALS PRIMARY CARE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, AUTH INDIVIDUAL
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:901-587-5050
Mailing Address - Street 1:PO BOX 38463
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38183-0463
Mailing Address - Country:US
Mailing Address - Phone:901-587-5050
Mailing Address - Fax:901-730-8985
Practice Address - Street 1:1264 WESLEY DR STE 601
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-6459
Practice Address - Country:US
Practice Address - Phone:901-587-5050
Practice Address - Fax:901-730-8985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-19
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty