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General NPI Number Information
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NPI Number | 1508662354
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Entity Type | Organization
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Legal Business Name | FAITH FAMILY WALK IN CLINIC LLC
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Dates
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Enumeration Date | 02/21/2025
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Last Update Date | 07/08/2025
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Provider Practice Location Address
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Address Line | 2095 SAINT JOHN AVE
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City | DYERSBURG
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State | TN
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Zip | 38024-2209
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Country | US
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Telephone | 731-445-5039
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Fax |
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Provider Business Mailing Address
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Address Line | 2095 SAINT JOHN AVE
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City | DYERSBURG
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State | TN
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Zip | 38024-2209
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Country | US
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Telephone | 731-334-5353
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Fax | 731-334-5418
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER
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Name | ANGELA UPCHURCH
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Credential | FNP
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Telephone | 731-334-5353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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