Westside Family Medical

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

20413 Issued in TN

Legal business name

WESTSIDE FAMILY MEDICAL

Practice address

104 Westside Dr
Tullahoma, TN 37388-3253

Phone

(931) 636-3176

NPI assigned

Jul 13, 2017

Last updated

Jul 13, 2017By 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

Leslie Lynette Myers, NP

Title

Nurse Practitioner

Phone

(931) 636-3176

Specialties & licenses 2

Addresses

Other identifiers 2

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/16264/brand/1/csg/1/fhir/r4

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

{
    "created_epoch": "1499904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1499904000000",
    "number": "1144742842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 CRESTVIEW DR",
            "city": "WINCHESTER",
            "state": "TN",
            "postal_code": "373982566",
            "telephone_number": "931-636-3176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 WESTSIDE DR",
            "city": "TULLAHOMA",
            "state": "TN",
            "postal_code": "373883253",
            "telephone_number": "931-636-3176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTSIDE FAMILY MEDICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-13",
        "last_updated": "2017-07-13",
        "status": "A",
        "authorized_official_last_name": "MYERS",
        "authorized_official_first_name": "LESLIE",
        "authorized_official_middle_name": "LYNETTE",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "931-636-3176",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "19352",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "20413",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1053780478",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1255720421",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Nurse Practitioner in Tullahoma, TN
• Providers in Tullahoma, 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 Jul 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.