Individual provider Active NPI

Jeonga Byeon

  • Family Nurse Practitioner
  • Chattanooga, TN
National Provider Identifier
1114747193
Registry record updated Oct 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
37292 Issued in TN
Practice address
2358 Lifestyle Way Ste 212
Chattanooga, TN 37421-4904
Phone
(423) 521-1100
Fax
(423) 521-1200
NPI assigned
Oct 14, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2024

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 37292 TN Primary

Addresses

Primary practice location

2358 Lifestyle Way Ste 212
Chattanooga, TN 37421-4904

Mailing address

136 Battlefield Crossing CT
Ringgold, GA 30736-5176
Phone (706) 277-7311

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
I20241204003963 TN Practitioner - Nurse Practitioner 3678009370 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Skin Cancer and Cosmetic Dermatology Center PCGroup PAC ID 8224118773, 29 clinicians

Practice addresses (Care Compare)

2358 Lifestyle Way
Suite 212
Chattanooga, TN 37421-4904
Phone (423) 521-1100

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Skin Cancer & Cosmetic Dermatology Center, PC CurrentSince Oct 15, 2024 Accepting new patients
Skin Cancer and Cosmetic Dermatology Center PC CurrentSince Oct 15, 2024 Accepting new patients

Locations

136 Battlefield Crossing Ct
#C
Ringgold, GA 30736

136 Battlefield Crossing Ct
Ringgold, GA 30736

2358 Lifestyle Way
Ste 212
Chattanooga, TN 37421
Phone (423) 521-1100

2253 Chambliss Ave NW
Ste 300
Cleveland, TN 37311
Phone (423) 472-3332

Organizations & group practices 2

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": "1728864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728864000000",
    "number": "1114747193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "136 BATTLEFIELD CROSSING CT",
            "city": "RINGGOLD",
            "state": "GA",
            "postal_code": "307365176",
            "telephone_number": "706-277-7311",
            "fax_number": "706-529-7210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2358 LIFESTYLE WAY STE 212",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374214904",
            "telephone_number": "423-521-1100",
            "fax_number": "423-521-1200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BYEON",
        "first_name": "JEONGA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-10-14",
        "last_updated": "2024-10-14",
        "certification_date": "2024-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "37292",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chattanooga, TN

Sources for this page

Verify at the official NPI Registry.