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General NPI Number Information
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NPI Number | 1285079558
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Entity Type | Organization
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Legal Business Name | EXPERIENCED CARE CLINIC INC.
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Dates
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Enumeration Date | 05/01/2013
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Last Update Date | 09/11/2024
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Provider Practice Location Address
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Address Line | 8008 MAIN ST
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City | POUND
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State | VA
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Zip | 24279-0000
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Country | US
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Telephone | 276-796-4586
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 908
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City | POUND
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State | VA
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Zip | 24279-0908
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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 | OWNER
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Name | MRS. TAMMY BRANHAM
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Credential | FNP
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Telephone | 276-393-8284
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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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 | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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