Justin Meredith
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Cub Run, KY
NPI 1033733605 · NPPES record last updated May 29, 2020
Key facts
- NPI
- 1033733605
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 56994 (TN)
- Practice address
- 424 Gap Hill Rd
Cub Run, KY 42729-9338 - Phone
- (270) 784-0194
- NPI assigned
- May 29, 2020
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 8
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Brownsville Medical Clinic, P.a.
BH Services Southeast 1 PC
Kentucky Post-Acute Medical Services 1 PSC
Ipc Pac Healthcare Services of Tennessee PC
Practice addresses (Care Compare)
2565 N Washington Ave
Brownsville, TN 38012-1610
2945 Smallhouse Rd
Bowling Green, KY 42104-4519
Phone (270) 842-0004
505 N Roan St
Johnson City, TN 37601-4740
Phone (423) 975-2000
723 Old Burkesville Rd
Albany, KY 42602-1654
Phone (606) 387-8000
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TN, KY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20201112001744 | TN | Practitioner - Nurse Practitioner | 5991115487 | Reassigns benefits to 4 organizations |
| I20240910002995 | KY | Practitioner - Nurse Practitioner | 5991115487 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 56994 | TN | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ipc Pac Healthcare Services of Tennessee PC | Psychiatric/Mental Health | Current |
Accepting new patients |
| CS Pacs 3 Southeast, LLC | Current |
Accepting new patients | |
| NV Pacs 2 LLC | Current |
Accepting new patients | |
| BH Services Southeast 1 PC | Current |
Accepting new patients | |
| Kentucky Post-Acute Medical Services 1 PSC | Psychiatric/Mental Health | Current |
Accepting new patients |
| Mi Pacs 2 PC | Past | Accepting new patients |
Locations
723 Burkesville Rd
Albany, KY 42602
Phone (606) 387-6421
55 Foundation Dr
Flemingsburg, KY 41041
Phone (606) 849-2351
1505 S Dixie St
Horse Cave, KY 42749
Phone (270) 786-2200
18 N Cavalier Dr
Alamo, TN 38001
Phone (731) 696-4500
880 S Mohawk Dr
Erwin, TN 37650
Phone (423) 743-7669
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 56994 | TN | Yes |
Addresses
Primary practice location
424 Gap Hill Rd
Cub Run, KY 42729-9338
Mailing address
424 Gap Hill Rd
Cub Run, KY 42729-9338
Phone (270) 784-0194
Other providers in Cub Run, KY
- Cumberland Family Medical Center Inc
- Kevin L Hayes
- Tabitha Rowlett
- Karinna Ann Snelling
- Diana D. Thompson
- Kimberly Thompson
All providers in Cub Run, KY · Psychiatric/Mental Health Nurse Practitioner in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 29, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.