=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922785047
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FALCON FAMILY HEALTHCARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2023
-----------------------------------------------------
Last Update Date | 06/30/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1421 HUNTSVILLE HWY
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37334-3605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 931-227-4197
-----------------------------------------------------
Fax | 931-208-3396
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1421 HUNTSVILLE HWY
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37334-3605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 931-227-4197
-----------------------------------------------------
Fax | 931-208-3396
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FAMILY NURSE PRACTITIONER
-----------------------------------------------------
Name | SHELANIA FOWLER
-----------------------------------------------------
Credential | NP-C
-----------------------------------------------------
Telephone | 931-227-4197
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------