Provider Demographics
NPI:1366717985
Name:TRAYLOR FAMILY HEALTH,LLC
Entity type:Organization
Organization Name:TRAYLOR FAMILY HEALTH,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MANAGER/NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:V
Authorized Official - Last Name:TRAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:931-206-1161
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:CUNNINGHAM
Mailing Address - State:TN
Mailing Address - Zip Code:37052-0128
Mailing Address - Country:US
Mailing Address - Phone:931-206-1161
Mailing Address - Fax:931-387-3935
Practice Address - Street 1:5923 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:ERIN
Practice Address - State:TN
Practice Address - Zip Code:37061
Practice Address - Country:US
Practice Address - Phone:931-206-1161
Practice Address - Fax:931-387-3935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-14
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7798363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty