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General NPI Number Information
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NPI Number | 1093845695
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Entity Type | Organization
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Legal Business Name | THE CLINIC, PLLC
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 04/07/2008
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Provider Practice Location Address
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Address Line | 520 E PARKVIEW ST
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City | DYERSBURG
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State | TN
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Zip | 38024-3114
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Country | US
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Telephone | 731-286-0490
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Fax | 731-286-0469
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Provider Business Mailing Address
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Address Line | 520 E PARKVIEW ST
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City | DYERSBURG
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State | TN
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Zip | 38024-3114
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Country | US
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Telephone | 731-286-0490
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Fax | 731-286-0469
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SYBLE S CARTER
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Credential | FNP
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Telephone | 731-286-0490
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APN 5212
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License Number State | TN
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