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General NPI Number Information
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NPI Number | 1861963050
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Entity Type | Organization
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Legal Business Name | LIVING HEALTHY WELLNESS CENTER
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Dates
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Enumeration Date | 12/16/2018
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Last Update Date | 04/12/2023
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Provider Practice Location Address
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Address Line | 414 W OLD HICKORY BLVD
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City | MADISON
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State | TN
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Zip | 37115-3653
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Country | US
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Telephone | 615-456-2016
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Fax | 615-454-2507
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Provider Business Mailing Address
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Address Line | 414 W OLD HICKORY BLVD
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City | MADISON
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State | TN
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Zip | 37115-3653
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Country | US
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Telephone | 615-454-2016
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Fax | 615-454-2507
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MRS. JOY RENEE GRIMES
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Credential | ACNP-BC
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Telephone | 615-454-2016
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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