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General NPI Number Information
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NPI Number | 1831373810
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Entity Type | Individual
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Provider Name | KRISTEN R DORTCH-FARMER PHYSICIAN ASSISTANT
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Gender | Female
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Dates
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Enumeration Date | 12/26/2007
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Last Update Date | 08/06/2022
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Provider Practice Location Address
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Address Line | 1469 TINY TOWN RD
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City | CLARKSVILLE
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State | TN
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Zip | 37042-7202
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Country | US
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Telephone | 931-343-3347
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Fax | 931-905-7008
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Provider Business Mailing Address
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Address Line | 392 GUNSON RIDGE RD
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City | CUMBERLAND CITY
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State | TN
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Zip | 37050-4369
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Country | US
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Telephone | 931-220-6258
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 1433
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License Number State | TN
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