=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023747995
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARE IN FAITH FAMILY WELLNESS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2022
-----------------------------------------------------
Last Update Date | 06/07/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1240 FOX MEADOWS BLVD STE 6
-----------------------------------------------------
City | SEVIERVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37862-6928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-286-9229
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 165 MCNABB ST
-----------------------------------------------------
City | NEWPORT
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37821-2025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-608-2800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JESI B WRIGHT
-----------------------------------------------------
Credential | FNP-C
-----------------------------------------------------
Telephone | 423-608-2800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------