Basic Information
| Provider Information | |||||||||
| NPI: | 1831501931 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RICE | ||||||||
| FirstName: | TINA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 109 HARRIS LN APT 10 | ||||||||
| Address2: | |||||||||
| City: | GALLATIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370668584 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6154736462 | ||||||||
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| Practice Location | |||||||||
| Address1: | 674 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | HENDERSONVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370752680 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158244552 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2014 | ||||||||
| LastUpdateDate: | 05/22/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 172V00000X | OTA0000002004 | TN | Y | Other Service Providers | Community Health Worker |
No ID Information.