Healthcare Provider Details

I. General information

NPI: 1396025854
Provider Name (Legal Business Name): BLESSED ASSURANCE LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2011
Last Update Date: 08/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 HATCHER CREEK LN
WALLAND TN
37886-2608
US

IV. Provider business mailing address

113 HATCHER CREEK LN
WALLAND TN
37886-2608
US

V. Phone/Fax

Practice location:
  • Phone: 865-809-5304
  • Fax: 865-982-2210
Mailing address:
  • Phone: 865-809-5304
  • Fax: 865-982-2210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number StateTN

VIII. Authorized Official

Name: MRS. AMY DENISE WILSON
Title or Position: OWNER
Credential:
Phone: 865-809-5304