NPIMap

Individual provider Active NPI

Heather Haddock, NP

  • Family Nurse Practitioner
  • Dyersburg, TN
National Provider Identifier
1003688474
Registry record updated Oct 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
34970 Issued in TN
Practice address
1718 Parr Ave Ste E
Dyersburg, TN 38024-2071
Phone
(731) 285-9938
NPI assigned
Oct 27, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 34970 TN Primary

Addresses

Primary practice location

1718 Parr Ave Ste E
Dyersburg, TN 38024-2071

Mailing address

1718 Parr Ave Ste E
Dyersburg, TN 38024-2071
Phone (731) 285-9938

Other names 1

  • Heather Fair Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231219001001 TN Practitioner - Nurse Practitioner 0648620575 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
SHC Medical Partners of Tennessee, LLC 21 clinicians
Abode Care Partners LTC VB LLC 81 clinicians

Practice addresses (Care Compare)

117 N Main St
Ridgely, TN 38080-1316
Phone (731) 264-5555

919 Medical Park Dr
Mountain City, TN 37683-1042
Phone (423) 727-7800

Hospital & facility affiliations

  • Jackson-Madison County General Hospital Hospital, Jackson, TN, CCN 440002
  • Dyersburg Regional Medical Center Hospital, Dyersburg, TN, CCN 440072

Merit-based Incentive Payment System (MIPS)

Final score
95.74 of 100Reported as apm
Quality
85.23
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Abode Care Partners Al VB, LLC CurrentSince Nov 25, 2024 Accepting new patients
Abode Care Partners Al VB, LLC CurrentSince Nov 25, 2024 Accepting new patients
Abode Care Partners LTC VB, LLC CurrentSince Nov 25, 2024 Accepting new patients
SHC Medical Partners of Tennessee, LLC CurrentSince Nov 25, 2024 Accepting new patients
Abode Care Partners LTC VB, LLC CurrentSince Nov 25, 2024 Accepting new patients

Locations

805 N Whittington Pkwy
Ste 400
Louisville, KY 40222
Phone (502) 272-3438

12201 Bluegrass Pkwy
Louisville, KY 40299
Phone (502) 568-7364

805 N Whittington Pkwy
Northfield, KY 40222
Phone (502) 627-7000

919 Medical Park Dr
Mountain City, TN 37683
Phone (423) 727-7800

415 Cole Dr
Pigeon Forge, TN 37863
Phone (865) 428-5454

117 N Main St
Ridgely, TN 38080
Phone (731) 264-5555

Interoperability endpoints

  • Direct secure messaging: hhaddock27947@directepic.wth.org

Organizations & group practices 18

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

View all 18

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1698364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698710400000",
    "number": "1003688474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1718 PARR AVE STE E",
            "city": "DYERSBURG",
            "state": "TN",
            "postal_code": "380242071",
            "telephone_number": "731-285-9938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1718 PARR AVE STE E",
            "city": "DYERSBURG",
            "state": "TN",
            "postal_code": "380242071",
            "telephone_number": "731-285-9938"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HADDOCK",
        "first_name": "HEATHER",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-10-27",
        "last_updated": "2023-10-31",
        "certification_date": "2023-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "34970",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HEATHER",
            "last_name": "FAIR",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Dyersburg, TN

Sources for this page

Verify at the official NPI Registry.