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General NPI Number Information
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NPI Number | 1396025854
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Entity Type | Organization
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Legal Business Name | BLESSED ASSURANCE LLC.
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Dates
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Enumeration Date | 08/27/2011
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Last Update Date | 08/27/2011
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Provider Practice Location Address
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Address Line | 113 HATCHER CREEK LN
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City | WALLAND
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State | TN
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Zip | 37886-2608
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Country | US
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Telephone | 865-809-5304
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Fax | 865-982-2210
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Provider Business Mailing Address
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Address Line | 113 HATCHER CREEK LN
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City | WALLAND
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State | TN
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Zip | 37886-2608
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Country | US
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Telephone | 865-809-5304
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Fax | 865-982-2210
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Authorized Official
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Title or Position | OWNER
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Name | MRS. AMY DENISE WILSON
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Credential |
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Telephone | 865-809-5304
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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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 | 305S00000X
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Taxonomy Name | Point of Service
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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 | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State | TN
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