Individual provider Active NPI

Pamela C Gunnell, FNP

  • Family Nurse Practitioner
  • Cookeville, TN
National Provider Identifier
1043214562
Registry record updated Jun 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN93501 Issued in TN
Practice address
67 N Washington Ave
Cookeville, TN 38501-3371
Phone
(931) 526-4004
Fax
(931) 526-4014
NPI assigned
Jun 13, 2005
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 10, 2020

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 RN93501 TN Primary

Addresses

Primary practice location

67 N Washington Ave
Cookeville, TN 38501-3371

Mailing address

221 N Oak Ave
Cookeville, TN 38501-2437
Phone (931) 526-4004

Other identifiers 1

IdentifierTypeStateIssuer
408-6954OtherTNBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040714001548 TN Practitioner - Nurse Practitioner 9537148507 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
RN93501TNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Diabetes & Geriatrics Specialist LLC CurrentSince Mar 31, 2020 Accepting new patients
North Willow Family Medicine LLC Past Accepting new patients
Vivian Family Medical LLC Past Accepting new patients

Locations

221 N Oak Ave
Cookeville, TN 38501
Phone (931) 525-6676

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/1385/brand/1/csg/1/fhir/r4

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1118620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591747200000",
    "number": "1043214562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 N OAK AVE",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385012437",
            "telephone_number": "931-526-4004",
            "fax_number": "931-526-4014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "67 N WASHINGTON AVE",
            "city": "COOKEVILLE",
            "state": "TN",
            "postal_code": "385013371",
            "telephone_number": "931-526-4004",
            "fax_number": "931-526-4014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUNNELL",
        "first_name": "PAMELA",
        "middle_name": "C",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-06-13",
        "last_updated": "2020-06-10",
        "certification_date": "2020-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "RN93501",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "408-6954",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cookeville, TN

Sources for this page

Verify at the official NPI Registry.