Gabriella Elizabeth Converse, PA
Individual provider Active NPI Medical Physician Assistant · White House, TN
NPI 1104633627 · NPPES record last updated May 15, 2025
Key facts
- NPI
- 1104633627
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- 6411 (TN)
- Practice address
- 128 Raymond Hirsch Pkwy
White House, TN 37188-8193 - Phone
- (615) 672-3027
- NPI assigned
- Dec 17, 2024
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- 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 |
|---|---|---|---|---|
| I20250723004472 | TN | Practitioner - Physician Assistant | 9830613835 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6411 | TN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hendersonville Hospital Corporation | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | |||
| Medical Physician Assistant | 363AM0700X | 6411 | TN | Yes |
Addresses
Primary practice location
128 Raymond Hirsch Pkwy
White House, TN 37188-8193
Mailing address
107 Judith CT
Goodlettsville, TN 37072-1337
Phone (315) 391-7550
Other providers in White House, TN
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- Sierra Combs
- Sarah Diane Cox
- Caitlyn Creasey
- Crossroads Medical Group, PLLC
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- Crossroads Medical Group, PLLC
All providers in White House, TN · Medical Physician Assistant in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 15, 2025. 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.