Healthcare Provider Details

I. General information

NPI: 1902470669
Provider Name (Legal Business Name): CHEROKEE QUICKCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2021
Last Update Date: 10/11/2021
Certification Date: 10/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 N HILL ST STE 4
TATUM TX
75691-1740
US

IV. Provider business mailing address

PO BOX 1129
TATUM TX
75691-1129
US

V. Phone/Fax

Practice location:
  • Phone: 903-947-2020
  • Fax: 903-947-3292
Mailing address:
  • Phone: 903-947-2020
  • Fax: 903-947-3292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH ANN BREEDLOVE
Title or Position: OWNER
Credential: MSN, APRN, FNP-C
Phone: 903-947-2020