Provider Demographics
NPI:1750921003
Name:MOBILE HEALING LLC
Entity type:Organization
Organization Name:MOBILE HEALING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:BROOKE
Authorized Official - Last Name:BLALOCK
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:731-676-0393
Mailing Address - Street 1:PO BOX 437
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:TN
Mailing Address - Zip Code:38063-0437
Mailing Address - Country:US
Mailing Address - Phone:731-676-0393
Mailing Address - Fax:
Practice Address - Street 1:4903 BRUCEVILLE SLAB RD
Practice Address - Street 2:
Practice Address - City:FRIENDSHIP
Practice Address - State:TN
Practice Address - Zip Code:38034-4325
Practice Address - Country:US
Practice Address - Phone:731-676-0393
Practice Address - Fax:731-256-6981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-14
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty