| Humboldt Family Walk-in Clinic Llc | |
|
1600 Coleman Dr Humboldt TN 38343-1756 | |
| (731) 470-4020 | |
| (731) 562-0349 |
| Full Name | Humboldt Family Walk-in Clinic Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1600 Coleman Dr, Humboldt, Tennessee |
| Authorized Official Name and Position | Deborah L Graves (OWNER) |
| Authorized Official Contact | 7314704020 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Humboldt Family Walk-in Clinic Llc 1600 Coleman Dr Humboldt TN 38343-0068 Ph: (731) 470-4020 | Humboldt Family Walk-in Clinic Llc 1600 Coleman Dr Humboldt TN 38343-1756 Ph: (731) 470-4020 |
| NPI Number | 1881135895 |
|---|---|
| Provider Enumeration Date | 03/10/2017 |
| Last Update Date | 12/09/2019 |
| Medicare PECOS PAC ID | 3072899434 |
|---|---|
| Medicare Enrollment ID | O20170810003221 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881135895 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
| Provider Name | Deborah Graves |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841404035 PECOS PAC ID: 7012094089 Enrollment ID: I20080402000167 |
| Provider Name | Jami Ivey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083797211 PECOS PAC ID: 8325357650 Enrollment ID: I20151027001901 |
| Provider Name | Sara E Ward |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992376115 PECOS PAC ID: 7618375882 Enrollment ID: I20211004000554 |
| Provider Name | Micah Whitnell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336845734 PECOS PAC ID: 0648636332 Enrollment ID: I20230523001448 |
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