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General NPI Number Information
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NPI Number | 1366224719
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Entity Type | Organization
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Legal Business Name | WILLOW OAK MEDICAL, LLC
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Dates
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Enumeration Date | 10/19/2023
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Last Update Date | 11/01/2023
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Provider Practice Location Address
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Address Line | 100 S MAIN ST
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City | CLINTON
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State | IN
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Zip | 47842-2437
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Country | US
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Telephone | 912-713-1124
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 467
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City | CLINTON
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State | IN
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Zip | 47842-0467
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Country | US
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Telephone | 912-713-1124
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JEANIE M KENT
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Credential | FNP-C
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Telephone | 912-713-1124
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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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