Provider Demographics
NPI:1285472993
Name:KIDS CARE PEDIATRIC AND FAMILY WELLNESS
Entity type:Organization
Organization Name:KIDS CARE PEDIATRIC AND FAMILY WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:423-437-8509
Mailing Address - Street 1:502 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:LA FOLLETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37766-3400
Mailing Address - Country:US
Mailing Address - Phone:423-201-1755
Mailing Address - Fax:
Practice Address - Street 1:502 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LA FOLLETTE
Practice Address - State:TN
Practice Address - Zip Code:37766-3400
Practice Address - Country:US
Practice Address - Phone:423-201-1755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-17
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty