MRS. BENITA K QUALLS (NPI# 1629245634) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629245634 |
| Entity Type | Individual |
| Full Name | MRS. BENITA K QUALLS |
| Other Name | MISS BENITA K ROBERTS |
| Credential | P.A. |
| Practice Address |
1407 W Baddour Pkwy Lebanon TN 37087-2513 |
| Practice Telephone | 6154446203 |
| Practice Fax Number | 6154446252 |
| Mailing Telephone | 6154446203 |
| Mailing Fax Number | 6154446252 |
| Enumeration Date | 2008-05-09 |
| Last Update Date | 2011-08-09 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 185 | TN | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | PHYSICIAN ASSISTANT LICENSE | 185 | 01 |
| TN | BCBS | 4298144 | 01 |
| TN | 1523861 | 05 | |
| TN | UHC | 3323092 | 01 |
| Street Address |
1407 W BADDOUR PKWY |
| City | LEBANON |
| State | TN |
| Zip Code | 37087-2513 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487610069 | Erin Mcculloch Crisp | Physician Assistant | 1407 W Baddour Pkwy, Lebanon, TN 37087-2513 | 2006-04-24 |
| 1518360874 | Lindsey Nicole Lattimore | Emergency Medical Technician, Intermediate | 1407 W Baddour Pkwy, Lebanon, TN 37087-2513 | 2014-10-01 |
| 1417296807 | Christine Corpuz Kowal | Nurse Practitioner | 1407 W Baddour Pkwy, Lebanon, TN 37087-2513 | 2013-02-05 |
| 1922359025 | John William Deason IIi | Pharmacist | 1407 W Baddour Pkwy, Lebanon, TN 37087-2513 | 2012-09-28 |
| 1073742250 | Richard A. Kincaid | Nurse Practitioner | 1407 W Baddour Pkwy, Lebanon, TN 37087-2513 | 2009-07-08 |
| 1629221692 | Tracy L Moss | Nurse Practitioner | 1407 W Baddour Pkwy, Lebanon, TN 37087-2513 | 2008-11-03 |
| 1306013305 | Jason L Black | Nurse Practitioner | 1407 W Baddour Pkwy, Lebanon, TN 37087-2513 | 2008-05-09 |
| 1083881064 | Jaime Christen Blaylock | Nurse Practitioner | 1407 W Baddour Pkwy, Lebanon, TN 37087-2513 | 2008-05-09 |
| 1255526380 | Keith T Winfree | Nurse Practitioner | 1407 W Baddour Pkwy, Lebanon, TN 37087-2513 | 2007-09-11 |
| 1174669998 | Bernard Tan Sy | Internal Medicine | 1407 W Baddour Pkwy, Lebanon, TN 37087-2513 | 2007-01-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467051698 | Results-ast Jv, LLC | Physical Therapist | 1420 West Baddour Parkway, Suite 102, Lebanon, TN 37087 | 2020-10-19 |
| 1306405725 | Angela Kurtz | Hearing Instrument Specialist | 1430 West Baddour Parkwayste D, Lebanon, TN 37087 | 2019-06-10 |
| 1164926937 | Andrea Christine Morrisett | Physical Therapist | 404 N Castle Heights Ave Ste G, Lebanon, TN 37087 | 2018-03-19 |
| 1942731492 | Rocky Mountain Holdings, LLC | Ambulance | 760d Franklin Rd, Lebanon, TN 37087 | 2017-03-27 |
| 1326409285 | Karina Lawrence | Speech-Language Pathologist | 1006 Keaton Street, Lebanon, TN 37087 | 2016-03-18 |
| 1174910491 | Yehualashet Bekele Hailemariam | Internal Medicine | 1411 W Baddour Pkwy,lebanon Tn 37087, Lebanon, TN 37087 | 2015-04-24 |
| 1043614829 | Jean Thompson | Behavioral Analyst | 1004 Hickory Hill Lane, Suite 2, Hermitage, TN 37087 | 2014-10-22 |
| 1588072771 | La Keisha Fair | Community Health Worker | 1 Cumberland Square, Lebanon, TN 37087 | 2014-07-31 |
| 1023440609 | James Martin Meadows | Specialist/Technologist | One Cumberland Square, Lebanon, TN 37087 | 2013-08-06 |
| 1336571231 | Lori Ann De Leo | Social Worker | 109 Autumn Creek, Lebanon, TN 37087 | 2013-08-01 |
| Find all providers in zip 37087 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275154536 | Hannah Stefanik | Physician Assistant | 1434 E 400 S, Lebanon, IN 46052-9761 | 2020-04-28 |
| 1144869546 | Jared W Swain | Physician Assistant | 7 Kimball St Apt 20, Lebanon, NH 03766-1736 | 2020-01-02 |
| 1225511801 | Thomas Carroll | Physician Assistant | 1633 W Main St Ste 300, Lebanon, TN 37087-7800 | 2018-09-10 |
| 1962863241 | Jonathan David Barnett | Physician Assistant | 1420 W Baddour Pkwy Ste 110, Lebanon, TN 37087-1510 | 2016-03-14 |
| 1942684584 | Samantha Pellechio | Physician Assistant | 60 Haytown Rd, Lebanon, NJ 08833-4004 | 2015-07-14 |
| 1386035756 | Whitney Hanor | Physician Assistant | 720 Spring Meadow Ln, Lebanon, TN 37087-3397 | 2015-02-06 |
| 1932504727 | Anthony Salvadore Petrole | Physician Assistant | 252 4th Street, Lebanon, PA 17042 | 2014-10-23 |
| 1144510538 | Derek Varney | Physician Assistant | 735 Norman Dr # Dr3, Lebanon, PA 17042-7559 | 2011-04-19 |
| 1457656902 | Scott Darron Fowler | Physician Assistant | 155 Legends Drive, Suite I, Lebanon, TN 37087 | 2011-01-13 |
| 1043408503 | Peter A Rosenblum | Physician Assistant | 525 N. Santiam Hwy., Lebanon, OR 97355-3982 | 2007-10-10 |
| Find all providers in LEBANON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.