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General NPI Number Information
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NPI Number | 1770012676
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Entity Type | Organization
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Legal Business Name | MAIN STREET FAMILY CARE PLLC
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Dates
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Enumeration Date | 06/06/2017
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Last Update Date | 10/31/2019
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Provider Practice Location Address
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Address Line | 211 CHURCH ST
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City | TIPTONVILLE
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State | TN
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Zip | 38079-1109
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Country | US
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Telephone | 731-571-0569
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Fax |
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Provider Business Mailing Address
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Address Line | 211 CHURCH ST
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City | TIPTONVILLE
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State | TN
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Zip | 38079-1109
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Country | US
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Telephone | 731-571-0569
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Fax |
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Authorized Official
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Title or Position | NP/OWNER
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Name | MISTY C BARKER
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Credential | NP-C
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Telephone | 731-571-0569
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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