Healthcare Provider Details

I. General information

NPI: 1083383053
Provider Name (Legal Business Name): MILK MEDIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2021
Last Update Date: 03/13/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 RICHARDSON LAKES DR
DRUMMONDS TN
38023-6278
US

IV. Provider business mailing address

375 RICHARDSON LAKES DRIVE
DRUMMONDS TN
38023
US

V. Phone/Fax

Practice location:
  • Phone: 901-626-6135
  • Fax: 901-443-1228
Mailing address:
  • Phone: 901-626-6135
  • Fax: 901-443-1228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number State

VIII. Authorized Official

Name: STEFANIE LOGAN
Title or Position: DIRECT OWNER
Credential: RN, IBCLC
Phone: 901-626-6135