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General NPI Number Information
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NPI Number | 1871528976
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Entity Type | Organization
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Legal Business Name | BOONES CREEK MEDICAL PLLC
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 02/13/2020
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Provider Practice Location Address
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Address Line | 2685 BOONES CREEK ROAD SUITE 104
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City | JOHNSON CITY
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State | TN
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Zip | 37615
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Country | US
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Telephone | 423-282-0636
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Fax | 423-282-1990
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Provider Business Mailing Address
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Address Line | 1000 W JACKSON BLVD STE 5
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City | JONESBOROUGH
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State | TN
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Zip | 37659-5397
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Country | US
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Telephone | 423-282-1990
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Fax | 423-282-1990
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | AMBER F WILKINSON
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Credential | FNP
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Telephone | 423-282-0636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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