=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104294776
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RIGHT CARE, SHELBYVILLE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2015
-----------------------------------------------------
Last Update Date | 09/16/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1731 N MAIN ST SUITE F
-----------------------------------------------------
City | SHELBYVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37160-2372
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 931-685-4510
-----------------------------------------------------
Fax | 931-684-9215
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1731 N MAIN ST SUITE F
-----------------------------------------------------
City | SHELBYVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37160-2372
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 931-685-4510
-----------------------------------------------------
Fax | 931-684-9215
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | C.O.O.
-----------------------------------------------------
Name | CHRISTOPHER NEBEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 615-480-0470
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------