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General NPI Number Information
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NPI Number | 1194502021
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Entity Type | Organization
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Legal Business Name | WALKING TREE FAMILY PRACTICE, INC
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Dates
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Enumeration Date | 09/13/2023
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Last Update Date | 09/13/2023
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Provider Practice Location Address
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Address Line | 3098 W LAKE MARY BLVD
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City | LAKE MARY
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State | FL
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Zip | 32746-6742
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Country | US
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Telephone | 406-855-9722
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Fax |
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Provider Business Mailing Address
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Address Line | 3098 W LAKE MARY BLVD
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City | LAKE MARY
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State | FL
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Zip | 32746-6742
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DR. FAIRBAIRN/OWNER
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Name | DR. BESSIE JOYCE FAIRBAIRN
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Credential | DNP, APRN, FNP-BC
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Telephone | 406-855-9722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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