Provider Demographics
NPI:1386875987
Name:HENSON'S FAMILY MEDICAL LLC
Entity type:Organization
Organization Name:HENSON'S FAMILY MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NIRSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:L
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:931-393-2362
Mailing Address - Street 1:622 WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-3265
Mailing Address - Country:US
Mailing Address - Phone:931-393-2362
Mailing Address - Fax:931-393-3210
Practice Address - Street 1:622 WILSON AVE
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-3265
Practice Address - Country:US
Practice Address - Phone:931-393-2362
Practice Address - Fax:931-393-3210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-30
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty