PROVIDENCE PEDIATRICS, LLC


Address: 140 Old Gray Station Road, Suite 200, Gray, TN 37615-3612
Phone: 4234772042

PROVIDENCE PEDIATRICS, LLC (NPI# 1821497942) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1821497942
Entity Type Organization
Organization Name PROVIDENCE PEDIATRICS, LLC
Practice Address 140 Old Gray Station Road
Suite 200
Gray
TN 37615-3612
Practice Telephone 4234772042
Practice Fax Number 4234774571
Mailing Telephone 4234772042
Mailing Fax Number 4234774571
Enumeration Date 2014-08-14
Last Update Date 2014-08-14
Authorized Official Name MS. SUSAN KAY PENNYPACKER (OWNER)
Authorized Official Telephone 4234772042
Authorized Official Credential FNP-C
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363L00000X Nurse Practitioner 6966 TN Physician Assistants & Advanced Practice Nursing Providers

Other Provider IDs and Locations

NPI Name Taxonomy Address Enumeration
1104086800 Providence Pediatrics, LLC Clinic/Center 2171 Northlake Pkwy, Suite 114, Tucker, GA 30084-4104 2008-06-16

Office Location

Street Address 140 OLD GRAY STATION ROAD
SUITE 200
City GRAY
State TN
Zip Code 37615-3612

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1568962983 Clayton Kilgore Pharmacist 208 Suncrest St Unit 1, Gray, TN 37615 2018-02-13
1346648268 Jesse Mullins Pharmacist 121 Boone Ridge Dr, Suite 1006, Johnson City, TN 37615 2014-12-09
1750650875 Medical Education Assistance Corporation Pediatrics 252 Sam Jenkins Rd, Attn: Dr. H. Patrick Stern, Gray, TN 37615 2011-12-19
1700018603 Anna Lynne Deal Nurse Practitioner 119 Boone Ridge Dr., Ste. 201, Johnson City, TN 37615 2009-08-11
1285876631 Leigh A Furman Occupational Therapist 253 Wiltshire Dr., Gray, TN 37615 2009-04-01
1811098908 Fay Lynn Bembry Nurse Practitioner 119 Boone Ridge Drive Ste. 201, Johnson City, TN 37615 2006-09-25
1871528976 Boones Creek Medical Pllc Family Medicine 2685 Boones Creek Road, Suite 104, Johnson City, TN 37615 2006-07-11
1568402048 Joseph Vincent Pinyard Jr. Family Medicine 880 Boones Station Rd, Johnson City, TN 37615 2006-06-07
1548223084 Pitchar Theerathorn Internal Medicine 119 Boone Ridge Drive, Suite 201, Johnson City, TN 37615 2006-04-07
1194717157 Susan Kay Pennypacker Nurse Practitioner 140 Old Gray Station Rd, Suite 200, Gray, TN 37615 2005-08-16
Find all providers in zip 37615

Taxonomy Information

Taxonomy Code 363L00000X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner

Taxonomy Definition

(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.
Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1023105780 Tammy L Freeman Nurse Practitioner 10755 N Us Highway 25e, Gray, KY 40734-6529 2006-10-06
1932155231 Diane J Aubrey Nurse Practitioner 20 Ramsdell Rd, Gray, ME 04039-7757 2006-05-26
1346242641 Knox County Family Practice Clinic, Inc. Nurse Practitioner 39 Cumberland Gap Plz, Ste 1, Gray, KY 40734-4536 2005-06-01
1134781073 Michael Kelly Nurse Practitioner 1005 Boulder Dr, Gray, GA 31032-6141 2019-07-01
1972893139 Melanie Dawn Davis Nurse Practitioner 115 Judge Gresham Rd, Suite B, Gray, TN 37615-6213 2011-04-08
1124339445 Leslie Busbee Miller Nurse Practitioner 1005 Boulder Dr, Gray, GA 31032 2010-07-01
1528295078 Calita Suzanne Hill Nurse Practitioner 1005 Boulder Dr, Gray, GA 31032 2009-06-11
1407002603 Loretta Sue Wilson Nurse Practitioner 39 Cumberland Gap Plz, Gray, KY 40734-4536 2008-08-07
1043402613 Brenda Gail Tolleson Nurse Practitioner 1005 Boulder Dr, Gray, GA 31032 2007-08-16
1568488823 Wendy Chartier Nurse Practitioner 115 Judge Gresham Rd, Suite B, Gray, TN 37615-6213 2006-07-13
Find all providers in GRAY

Competitor

Search similar providers

City GRAY
Zip Code 37615

Improve Information

Please comment or provide details below to improve the information on PROVIDENCE PEDIATRICS, LLC.

Dataset Information

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.

Trending Searches