| Mending Hearts Wellness Center Of Tennessee Llc | |
|
854 Highway 92 S Ste B Dandridge TN 37725-4969 | |
| (865) 484-9355 | |
| (865) 484-9899 |
| Full Name | Mending Hearts Wellness Center Of Tennessee Llc |
|---|---|
| Speciality | Psychologist |
| Location | 854 Highway 92 S Ste B, Dandridge, Tennessee |
| Authorized Official Name and Position | Christi D Banks (OWNER) |
| Authorized Official Contact | 8655796756 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mending Hearts Wellness Center Of Tennessee Llc Po Box 1205 Dandridge TN 37725-1205 Ph: (865) 484-9355 | Mending Hearts Wellness Center Of Tennessee Llc 854 Highway 92 S Ste B Dandridge TN 37725-4969 Ph: (865) 484-9355 |
| NPI Number | 1740959683 |
|---|---|
| Provider Enumeration Date | 09/13/2021 |
| Last Update Date | 09/13/2024 |
| Certification Date | 09/13/2024 |
| Medicare PECOS PAC ID | 6103215173 |
|---|---|
| Medicare Enrollment ID | O20211112000518 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740959683 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TP0016X | Psychologist - Prescribing (medical) | (* (Not Available)) | Primary |
| Provider Name | Christi D Banks |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992823512 PECOS PAC ID: 7012306095 Enrollment ID: I20211112001143 |
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