Provider Demographics
NPI:1861262537
Name:ADVANCED CARE AND MEDSPA, LLC
Entity type:Organization
Organization Name:ADVANCED CARE AND MEDSPA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NP
Authorized Official - Prefix:
Authorized Official - First Name:KALIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FAULKNER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:615-447-3981
Mailing Address - Street 1:139 MAPLE ROW BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-4490
Mailing Address - Country:US
Mailing Address - Phone:615-447-3981
Mailing Address - Fax:615-503-8096
Practice Address - Street 1:139 MAPLE ROW BLVD STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-4490
Practice Address - Country:US
Practice Address - Phone:615-447-3981
Practice Address - Fax:615-503-8096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-04
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty