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General NPI Number Information
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NPI Number | 1851164560
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Entity Type | Organization
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Legal Business Name | WADDELL CLINIC PRIMARY CARE & AESTHETICS PLLC
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Dates
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Enumeration Date | 11/03/2023
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Last Update Date | 05/31/2024
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Provider Practice Location Address
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Address Line | 9785 HWY 79 S
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City | HENRY
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State | TN
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Zip | 38231
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Country | US
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Telephone | 731-423-1450
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Fax | 731-423-1000
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Provider Business Mailing Address
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Address Line | 9785 HIGHWAY 79 S
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City | HENRY
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State | TN
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Zip | 38231-3613
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Country | US
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Telephone | 731-243-1450
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Fax | 731-243-1000
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Authorized Official
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Title or Position | OWNER
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Name | DONNA WADDELL
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Credential | NP-C
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Telephone | 731-415-8277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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