Healthcare Provider Details

I. General information

NPI: 1932779170
Provider Name (Legal Business Name): KIDNEY CARE CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 N WILLOW AVE STE C
COOKEVILLE TN
38501-2354
US

IV. Provider business mailing address

427 N WILLOW AVE STE C
COOKEVILLE TN
38501-2354
US

V. Phone/Fax

Practice location:
  • Phone: 931-650-0076
  • Fax:
Mailing address:
  • Phone: 931-559-5959
  • Fax: 833-992-2327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. ZAID BRIFKANI
Title or Position: OWNER
Credential:
Phone: 931-650-0076