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).
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 |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 6966 | TN | Physician Assistants & Advanced Practice Nursing Providers |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1104086800 | Providence Pediatrics, LLC | Clinic/Center | 2171 Northlake Pkwy, Suite 114, Tucker, GA 30084-4104 | 2008-06-16 |
Street Address |
140 OLD GRAY STATION ROAD SUITE 200 |
City | GRAY |
State | TN |
Zip Code | 37615-3612 |
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 Code | 363L00000X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Nurse Practitioner |
(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. |
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 |
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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.