=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760861546
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOBEY CLINIC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/26/2015
-----------------------------------------------------
Last Update Date | 05/26/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 70 CLAY ST ST 5
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38060-5219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-465-8333
-----------------------------------------------------
Fax | 901-465-8006
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 372
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38060-0372
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-465-8333
-----------------------------------------------------
Fax | 901-465-8006
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING PARTNER
-----------------------------------------------------
Name | BETH TOBEY
-----------------------------------------------------
Credential | FNP-BC
-----------------------------------------------------
Telephone | 901-465-8333
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 5592
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------