Registry details
Type
Individual
Primary specialty
Nurse Practitioner, Family
Enumerated
Oct 12, 2017
License(s)
194315 (TN), 23304 (TN)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 301 MED TECH PKWY STE 120 | Johnson City, TN 37604-2631 | 423-794-5590 |
| MAILING | PO BOX 632476 | Cincinnati, OH 45263-2476 | 423-794-5590 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.