Provider Demographics
NPI:1104469428
Name:KNOX HEADACHE AND WELLNESS CENTER LLC
Entity type:Organization
Organization Name:KNOX HEADACHE AND WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:H
Authorized Official - Last Name:QUALLS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:865-566-7520
Mailing Address - Street 1:4612 E JOYCE LN
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37849-5155
Mailing Address - Country:US
Mailing Address - Phone:865-566-7520
Mailing Address - Fax:
Practice Address - Street 1:4612 E JOYCE LN
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849-5155
Practice Address - Country:US
Practice Address - Phone:865-566-7520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center