Healthcare Provider Details

I. General information

NPI: 1588022727
Provider Name (Legal Business Name): FRONT PAGE FAME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2016
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 DIRECTORS ROW
JACKSON TN
38305-2316
US

IV. Provider business mailing address

541 WILEY PARKER RD
JACKSON TN
38305-2226
US

V. Phone/Fax

Practice location:
  • Phone: 731-203-0708
  • Fax:
Mailing address:
  • Phone: 731-203-0708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. KIMBERLY LOVELADY
Title or Position: OWNER/CO-FOUNDER
Credential: MPH, MSW
Phone: 731-203-0708