NPIMap

Organization Active NPI

Premier Wound Care of Tennessee, PC

  • Family Nurse Practitioner
  • Morristown, TN
National Provider Identifier
1104702729
Registry record updated Jun 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
PREMIER WOUND CARE OF TENNESSEE, PC
Practice address
1907 W Morris Blvd Ste A200
Morristown, TN 37813-3880
Phone
(423) 522-8700
Fax
(423) 522-8701
NPI assigned
Aug 12, 2025
Last updated
Jun 10, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2026

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

Authorized official

Name
Leonard Hales
Title
Credentialing
Phone
(423) 522-8700

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Specialty Clinic/Center 261QM2500X
Family Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LF0000X Primary

Addresses

Primary practice location

1907 W Morris Blvd Ste A200
Morristown, TN 37813-3880

Mailing address

1326 Papermill Pointe Way
Knoxville, TN 37909-1903
Phone (423) 522-8700

Other identifiers 1

IdentifierTypeStateIssuer
Q105544MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20251125003899 TN Part B Supplier - Clinic/Group Practice 7214429307 Receives reassigned benefits from 10 practitioners
2 other NPIs on this enrollment
Practice locations: Gray, TN; Morristown, TN; Knoxville, TN

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Premier Wound Care of Tennessee PC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 10

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": "1754956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1781049600000",
    "number": "1104702729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1326 PAPERMILL POINTE WAY",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379091903",
            "telephone_number": "423-522-8700",
            "fax_number": "423-522-8701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1907 W MORRIS BLVD STE A200",
            "city": "MORRISTOWN",
            "state": "TN",
            "postal_code": "378133880",
            "telephone_number": "423-522-8700",
            "fax_number": "423-522-8701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER WOUND CARE OF TENNESSEE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-08-12",
        "last_updated": "2026-06-10",
        "certification_date": "2026-06-10",
        "status": "A",
        "authorized_official_last_name": "HALES",
        "authorized_official_first_name": "LEONARD",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "423-522-8700"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q105544",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Morristown, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.