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General NPI Number Information
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NPI Number | 1679928485
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Entity Type | Organization
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Legal Business Name | HEALTHY LIFE FAMILY MEDICINE LLPC
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Dates
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Enumeration Date | 04/29/2016
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Last Update Date | 07/06/2016
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Provider Practice Location Address
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Address Line | 1383 S COLLEGE ST STE. 2
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City | WINCHESTER
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State | TN
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Zip | 37398-2414
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Country | US
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Telephone | 931-810-8012
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Fax | 931-241-6630
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Provider Business Mailing Address
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Address Line | 1383 S COLLEGE ST STE. 2
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City | WINCHESTER
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State | TN
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Zip | 37398-2414
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Country | US
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Telephone | 931-810-8012
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Fax | 931-241-6630
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Authorized Official
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Title or Position | OWNER
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Name | SHERRI L. WALKER
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Credential | DO
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Telephone | 814-860-1710
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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 | 2308
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License Number State | TN
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