=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720893548
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VALLEY BEAUTIFUL HEALTHCARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/10/2025
-----------------------------------------------------
Last Update Date | 02/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 647 N MAIN AVENUE
-----------------------------------------------------
City | ERWIN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37650-1319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-735-3405
-----------------------------------------------------
Fax | 423-735-3408
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 647 N MAIN AVENUE
-----------------------------------------------------
City | ERWIN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37650
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-735-3405
-----------------------------------------------------
Fax | 423-735-3408
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLER
-----------------------------------------------------
Name | JENNIFER GARMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 540-443-6080
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------