Organization Active NPI

King Family Medical PLLC

  • Primary Care Clinic/Center
  • Waverly, TN
National Provider Identifier
1053547760
Registry record updated Jun 30, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
13621 Issued in TN
Legal business name
KING FAMILY MEDICAL PLLC
Practice address
215B Holly LN
Waverly, TN 37185-3387
Phone
(931) 296-9969
Fax
(931) 296-8100
NPI assigned
Jun 9, 2009
Last updated
Jun 30, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2016

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

Authorized official

Name
Mrs. Christie Madge King-Patterson, NP-CNPI 1477703155
Title
Owner
Phone
(931) 296-9969

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 13621 TN Primary

Addresses

Primary practice location

215B Holly LN
Waverly, TN 37185-3387

Mailing address

PO Box 432
Waverly, TN 37185-0432

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1244505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467244800000",
    "number": "1053547760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 432",
            "city": "WAVERLY",
            "state": "TN",
            "postal_code": "371850432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215B HOLLY LN",
            "city": "WAVERLY",
            "state": "TN",
            "postal_code": "371853387",
            "telephone_number": "931-296-9969",
            "fax_number": "931-296-8100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KING FAMILY MEDICAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-09",
        "last_updated": "2016-06-30",
        "status": "A",
        "authorized_official_last_name": "KING-PATTERSON",
        "authorized_official_first_name": "CHRISTIE",
        "authorized_official_middle_name": "MADGE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "931-296-9969",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "NP-C"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "TN",
            "license": "13621",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waverly, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.