Park Medical

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

PARK MEDICAL

Practice address

13851 Highway 28
Whitwell, TN 37397-5373

Phone

(423) 658-9200

Fax

(423) 658-2195

NPI assigned

Nov 16, 2022

Organization subpart

No

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

Authorized official

Name

James Kennedy

Title

Owner

Phone

(423) 658-9200

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TN2 enrollments

Enrollment records 2

Rural health clinic certification: CCN 883974

Legal name

PARK MEDICAL

Doing business as

PHOENIX RURAL HEALTH CLINICS OF TENNESSEE - WHITWELL

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Jul 1, 2024

Last certification

Jul 1, 2024

Ownership / control type

1B

Organization structure

LLCProprietary

Enrollment address

13851 Highway 28
Whitwell, TN 37397-5373

Locations

All disclosed owners & managing parties 6

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Mark Allen Clapp, M.D.

  • Family Medicine Physician
  • Cookeville, TN
  • NPI 1376592782

  5% Or Greater Direct Ownership Interest, Operational/Managerial Control

  CMS ownership
• Charlie Weichin Fang, MD

  • Family Medicine Physician
  • Whitwell, TN
  • NPI 1609962521

  5% Or Greater Direct Ownership Interest, Operational/Managerial Control

  CMS ownership

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Charlie Weichin Fang, MD

  • Family Medicine Physician
  • Whitwell, TN
  • NPI 1609962521
  Medicare reassignment Care Compare group NPD
• Michelle Denise Gulley, FNP-C

  • Family Nurse Practitioner
  • Whitwell, TN
  • NPI 1245022219
  Medicare reassignment Care Compare group NPD
• Alan Dewitt Kennett Kelley, MD

  • Family Medicine Physician
  • Whitwell, TN
  • NPI 1558343087
  Medicare reassignment Care Compare group NPD
• Jung Tae Park, MD

  • Adult Medicine Physician
  • Whitwell, TN
  • NPI 1942291638
  Medicare reassignment Care Compare group NPD
• Ashley Ann Sartain, FNP-C

  • Nurse Practitioner
  • Coalmont, TN
  • NPI 1245791201
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1668556800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1784592000000",
    "number": "1124737408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13851 HIGHWAY 28",
            "city": "WHITWELL",
            "state": "TN",
            "postal_code": "373975373",
            "telephone_number": "423-658-9200",
            "fax_number": "423-658-2195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13851 HIGHWAY 28",
            "city": "WHITWELL",
            "state": "TN",
            "postal_code": "373975373",
            "telephone_number": "423-658-9200",
            "fax_number": "423-658-2195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK MEDICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-16",
        "last_updated": "2026-07-21",
        "certification_date": "2026-07-21",
        "status": "A",
        "authorized_official_last_name": "KENNEDY",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "423-658-9200"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jarrett Kilgore
• Nonie Ivey Linder, LCSW
• Ingrid Rene Long, REGISTERED NURSE
• Frederick Kirk McDermott, M.A., LPC, MHSP
• David Alford Nunley
• Jung Tae Park, MD
• Kimberly Gean Redfearn, NP-C
• Delanie Alexis Roberts
• Donald Allen Smith
• Southern Home Care Services, Inc.

• Rural Health Clinic/Center in Whitwell, TN
• Providers in Whitwell, TN by specialty
• Rural Health Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.