Healthcare Provider Details

I. General information

NPI: 1104366988
Provider Name (Legal Business Name): NEIGHBORHOOD CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N BREWER ST
PARIS TN
38242-4027
US

IV. Provider business mailing address

1190 PETTIJOHN CREEK RD
HENRY TN
38231-4123
US

V. Phone/Fax

Practice location:
  • Phone: 731-415-3574
  • Fax: 731-240-0232
Mailing address:
  • Phone: 731-499-2319
  • Fax: 866-670-8568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN7205
License Number StateTN

VIII. Authorized Official

Name: MR. STEVE PROSSER
Title or Position: PRACTICE MANAGER
Credential:
Phone: 731-499-2319