Family Medical Center of Decherd Inc.

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

6754 Issued in TN

Legal business name

FAMILY MEDICAL CENTER OF DECHERD INC.

Practice address

3651 Tullahoma Hwy
Winchester, TN 37398-4940

Phone

(931) 962-4082

Fax

(931) 962-4084

NPI assigned

Jul 31, 2007

Last updated

Aug 6, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Kimberly A. Perry, FNPNPI 1457316630

Title

President/Family Nurse Practitioner

Phone

(931) 962-4082

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Locations

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.

• Kimberly Ann Perry, FNP

  • Family Nurse Practitioner
  • Winchester, TN
  • NPI 1457316630
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1185840000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217980800000",
    "number": "1124218631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3651 TULLAHOMA HWY",
            "city": "WINCHESTER",
            "state": "TN",
            "postal_code": "373984940",
            "telephone_number": "931-962-4082",
            "fax_number": "931-962-4084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3651 TULLAHOMA HWY",
            "city": "WINCHESTER",
            "state": "TN",
            "postal_code": "373984940",
            "telephone_number": "931-962-4082",
            "fax_number": "931-962-4084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY MEDICAL CENTER OF DECHERD INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-31",
        "last_updated": "2008-08-06",
        "status": "A",
        "authorized_official_last_name": "PERRY",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "PRESIDENT/FAMILY NURSE PRACTITIONER",
        "authorized_official_telephone_number": "931-962-4082",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "6754",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "3724619",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PPN",
            "identifier": "3341708",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3724619",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Nurse Practitioner in Winchester, TN
• Providers in Winchester, TN by specialty
• Family Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2008; 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.