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General NPI Number Information
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NPI Number | 1285279265
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Entity Type | Organization
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Legal Business Name | DEFINITE WELLNESS
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Dates
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Enumeration Date | 11/13/2019
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Last Update Date | 11/13/2019
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Provider Practice Location Address
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Address Line | 401 WILSON AVE
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City | TULLAHOMA
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State | TN
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Zip | 37388-3357
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Country | US
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Telephone | 931-434-2140
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Fax |
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Provider Business Mailing Address
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Address Line | 401 WILSON AVE
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City | TULLAHOMA
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State | TN
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Zip | 37388-3357
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Country | US
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Telephone | 931-434-2140
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CANDICE MARIE KINNEY
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Credential | FNP
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Telephone | 931-434-0439
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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 |
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License Number State |
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