Provider Demographics
NPI:1386049476
Name:KAFUL DOUBLE PORTION FAMILY PRACTICE, INC
Entity type:Organization
Organization Name:KAFUL DOUBLE PORTION FAMILY PRACTICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:423-339-7107
Mailing Address - Street 1:3740 OCOEE PLACE NW
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312
Mailing Address - Country:US
Mailing Address - Phone:423-339-7107
Mailing Address - Fax:423-339-6717
Practice Address - Street 1:3740 OCOEE PLACE NW
Practice Address - Street 2:SUITE 101
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312
Practice Address - Country:US
Practice Address - Phone:423-339-7107
Practice Address - Fax:423-339-6717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-31
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000014265363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty