| Online Wound Care Group Pllc | |
|
101 Westpark Dr Brentwood TN 37027-5031 | |
| (910) 310-4551 | |
| Not Available |
| Full Name | Online Wound Care Group Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 101 Westpark Dr, Brentwood, Tennessee |
| Authorized Official Name and Position | Stacey Raybuck (PRESIDENT) |
| Authorized Official Contact | 9103104551 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Online Wound Care Group Pllc 101 Westpark Dr Brentwood TN 37027-5031 Ph: (910) 310-4551 | Online Wound Care Group Pllc 101 Westpark Dr Brentwood TN 37027-5031 Ph: (910) 310-4551 |
| NPI Number | 1487345369 |
|---|---|
| Provider Enumeration Date | 05/19/2023 |
| Last Update Date | 05/19/2023 |
| Medicare PECOS PAC ID | 8729504683 |
|---|---|
| Medicare Enrollment ID | O20250424000710 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487345369 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Stephanie Brooke Duffer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578706701 PECOS PAC ID: 2062673858 Enrollment ID: I20120423000618 |
| Provider Name | Kristina Favaloro |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306294327 PECOS PAC ID: 3678830346 Enrollment ID: I20171205002105 |
| Provider Name | Alexandra Lukianoff |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1427219583 PECOS PAC ID: 5890017552 Enrollment ID: I20200611001022 |
| Provider Name | Ashley Dawn Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386322774 PECOS PAC ID: 4082059811 Enrollment ID: I20240301003033 |
| Provider Name | Elizabeth Diane Payne |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700831138 PECOS PAC ID: 1658497037 Enrollment ID: I20250507000964 |
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