Indian Lake Medical Weight Loss & Wellness, PLLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

12512 Issued in TN

Legal business name

INDIAN LAKE MEDICAL WEIGHT LOSS & WELLNESS, PLLC

Practice address

133 Indian Lake Rd
Suite 204
Hendersonville, TN 37075-3883

Phone

(615) 822-9002

NPI assigned

Sep 14, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Tomeka Taylor Minchey, NURSE PRACTITIONER

Title

Owner

Phone

(615) 822-9002

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1252886400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1252886400000",
    "number": "1073846697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "133 INDIAN LAKE RD",
            "address_2": "SUITE 204",
            "city": "HENDERSONVILLE",
            "state": "TN",
            "postal_code": "370753883",
            "telephone_number": "615-822-9002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "133 INDIAN LAKE RD",
            "address_2": "SUITE 204",
            "city": "HENDERSONVILLE",
            "state": "TN",
            "postal_code": "370753883",
            "telephone_number": "615-822-9002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIAN LAKE MEDICAL WEIGHT LOSS & WELLNESS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-14",
        "last_updated": "2009-09-14",
        "status": "A",
        "authorized_official_last_name": "MINCHEY",
        "authorized_official_first_name": "TOMEKA",
        "authorized_official_middle_name": "TAYLOR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "615-822-9002",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "NURSE PRACTITIONER"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "TN",
            "license": "12512",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Clinic/Center in Hendersonville, TN
• Providers in Hendersonville, TN by specialty
• Primary Care Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.