Active NPI
Myria Jan Weems
- Speech-Language Pathologist
- Johnson City, TN
National Provider Identifier
1124699145
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 2564
- Practice address
- 2214 E Fairview Ave
Johnson City, TN 37601-2860 - Phone
- (423) 928-6464
- Fax
- (423) 232-7970
- NPI assigned
- Jul 9, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 2564 | TN | Primary |
Addresses
Primary practice location
2214 E Fairview Ave
Johnson City, TN 37601-2860
Mailing address
PO Box 191
Johnson City, TN 37605-0191
Phone (423) 928-6464
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2564 | Other | TN | TENNESSEE LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2564 | TN | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fairview Therapy | Speech-Language Pathologist | Current | Accepting new patients |
| Mini Miracles Pediatric Therapy, PLLC | Current | Accepting new patients |
Locations
2214 E Fairview Ave
Johnson City, TN 37601
Phone (423) 928-6464
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.
-
- Early Intervention Provider Agency
- Johnson City, TN
- NPI 1831774637
Speech-Language Pathologist
-
- Early Intervention Provider Agency
- Johnson City, TN
- NPI 1477991560
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1625788800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1625788800000",
"number": "1124699145",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 191",
"city": "JOHNSON CITY",
"state": "TN",
"postal_code": "376050191",
"telephone_number": "423-928-6464",
"fax_number": "423-232-7970"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2214 E FAIRVIEW AVE",
"city": "JOHNSON CITY",
"state": "TN",
"postal_code": "376012860",
"telephone_number": "423-928-6464",
"fax_number": "423-232-7970"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WEEMS",
"first_name": "MYRIA",
"middle_name": "JAN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-07-09",
"last_updated": "2021-07-09",
"certification_date": "2021-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "TN",
"license": "2564",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TENNESSEE LICENSE",
"identifier": "2564",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Johnson City, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.