Individual provider Active NPI

Kyanna Soler, FNP-C

  • Family Nurse Practitioner
  • Jackson, TN
National Provider Identifier
1104490473
Registry record updated Jan 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
29761 Issued in TN
Practice address
1356 Union University Drive
Suite G
Jackson, TN 38305
Phone
(731) 300-7311
NPI assigned
May 19, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2025

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 29761 TN Primary

Addresses

Primary practice location

1356 Union University Drive
Suite G
Jackson, TN 38305

Mailing address

1356 Union University Drive
Suite G
Jackson, TN 38305
Phone (731) 300-7311

Other practice location 1

4055 N Park Loop
Memphis, TN 38152-9735
Phone (901) 678-2003

Other practice location 2

14510 Highway 79
Mc Kenzie, TN 38201-7824
Phone (731) 394-1145

Other practice location 3

2036 US Highway 45 Byp S
Trenton, TN 38382-2941
Phone (731) 394-1145

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
I20241230000254 TN Practitioner - Nurse Practitioner 2567999790

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Med RX Pharmacy PC CurrentSince Aug 1, 2021 Accepting new patients

Locations

1356 Union University Dr
Ste G
Jackson, TN 38305
Phone (731) 300-7311

Organizations & group practices 1

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": "1621382400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736380800000",
    "number": "1104490473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1356 UNION UNIVERSITY DRIVE",
            "address_2": "SUITE G",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "38305",
            "telephone_number": "731-300-7311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1356 UNION UNIVERSITY DRIVE",
            "address_2": "SUITE G",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "38305",
            "telephone_number": "731-300-7311"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4055 N Park Loop",
            "address_purpose": "LOCATION",
            "city": "Memphis",
            "state": "TN",
            "postal_code": "381529735",
            "country_code": "US",
            "telephone_number": "901-678-2003",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "14510 Highway 79",
            "address_purpose": "LOCATION",
            "city": "Mc Kenzie",
            "state": "TN",
            "postal_code": "382017824",
            "country_code": "US",
            "telephone_number": "731-394-1145",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2036 US Highway 45 Byp S",
            "address_purpose": "LOCATION",
            "city": "Trenton",
            "state": "TN",
            "postal_code": "383822941",
            "country_code": "US",
            "telephone_number": "731-394-1145",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SOLER",
        "first_name": "KYANNA",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-19",
        "last_updated": "2025-01-09",
        "certification_date": "2025-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "29761",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, TN

Sources for this page

Verify at the official NPI Registry.