Provider Demographics
NPI:1962785071
Name:GET WELL FAMILY CLINIC LLC
Entity type:Organization
Organization Name:GET WELL FAMILY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FNP
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:L
Authorized Official - Last Name:FARHAT
Authorized Official - Suffix:
Authorized Official - Credentials:FNP, BC
Authorized Official - Phone:800-568-0870
Mailing Address - Street 1:375 VANN DR
Mailing Address - Street 2:STE A
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-6027
Mailing Address - Country:US
Mailing Address - Phone:800-568-0870
Mailing Address - Fax:731-256-7324
Practice Address - Street 1:375 VANN DR
Practice Address - Street 2:STE A
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-6027
Practice Address - Country:US
Practice Address - Phone:800-568-0870
Practice Address - Fax:731-256-7324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-25
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN6504363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNS73345Medicare UPIN