Basic Information
| Provider Information | |||||||||
| NPI: | 1699091447 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARING FAMILY PRACTICE PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 311 LANDRUM PLACE | ||||||||
| Address2: | SUITE C500 | ||||||||
| City: | CLARKSVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9312452086 | ||||||||
| FaxNumber: | 9312452087 | ||||||||
| Practice Location | |||||||||
| Address1: | 311 LANDRUM PLACE | ||||||||
| Address2: | SUITE C500 | ||||||||
| City: | CLARKSVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9312452086 | ||||||||
| FaxNumber: | 9312452087 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2010 | ||||||||
| LastUpdateDate: | 08/12/2010 | ||||||||
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| AuthorizedOfficialLastName: | THOMAS | ||||||||
| AuthorizedOfficialFirstName: | KIMBERLY | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9312452086 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | CFNP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APN0000006394 | TN | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 4259723 | 01 | TN | BLUE CROSS OF TN GROUP | OTHER | 3904561 | 05 | TN | MEDICAID | 4265147 | 01 | TN | BLUE CROSS OF TN | OTHER | 1517675 | 01 | TN | MEDICAID GROUP | OTHER |