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General NPI Number Information
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NPI Number | 1013469725
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Entity Type | Organization
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Legal Business Name | FOREVERYOUNG WELLNESS
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Dates
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Enumeration Date | 10/28/2016
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Last Update Date | 10/28/2016
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Provider Practice Location Address
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Address Line | 5816 KINGSTON PIKE STE 1
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City | KNOXVILLE
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State | TN
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Zip | 37919-6341
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Country | US
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Telephone | 865-444-2130
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Fax |
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Provider Business Mailing Address
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Address Line | 5816 KINGSTON PIKE STE 1
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City | KNOXVILLE
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State | TN
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Zip | 37919-6341
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Country | US
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Telephone | 865-444-2130
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JACKIE ZGIET
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Credential | FNP
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Telephone | 865-444-2130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 16115
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License Number State | TN
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