Healthcare Provider Details

I. General information

NPI: 1194835645
Provider Name (Legal Business Name): DEBORAH VERBEEK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 12/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25495 MAIN ST
ARDMORE TN
38449-3129
US

IV. Provider business mailing address

25495 MAIN ST
ARDMORE TN
38449-3129
US

V. Phone/Fax

Practice location:
  • Phone: 931-427-6969
  • Fax: 931-427-6967
Mailing address:
  • Phone: 931-427-6969
  • Fax: 931-427-6967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH R VERBEEK
Title or Position: OWNER
Credential: CFNP
Phone: 931-427-6969