Individual provider Active NPI

Kristie Zimmerman, NP

  • Family Nurse Practitioner
  • Waverly, TN
National Provider Identifier
1154910230
Registry record updated Jan 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
28102 Issued in TN
Practice address
301 W Main St
Waverly, TN 37185-1512
Phone
(931) 299-7378
Fax
(931) 299-7399
NPI assigned
Jan 13, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2021

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 28102 TN Primary

Addresses

Primary practice location

301 W Main St
Waverly, TN 37185-1512

Mailing address

120 Atchison Rd
Springville, TN 38256-6455
Phone (731) 363-0724

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
I20210122002610 TN Practitioner - Nurse Practitioner 6709290273 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fast Pace Medical Clinic PLLCGroup PAC ID 5395881841, 737 clinicians

Practice addresses (Care Compare)

301 W Main St
Waverly, TN 37185-1512
Phone (615) 988-1571

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Fast Pace Medical Clinic PLLC CurrentSince Jan 7, 2021 Accepting new patients
Fast Pace Medical Clinic PLLC CurrentSince Jan 7, 2021 Accepting new patients

Locations

284 Highway 641 N
Camden, TN 38320
Phone (731) 213-2446

301 W Main St
Waverly, TN 37185
Phone (931) 299-7378

Organizations & group practices 3

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": "1610496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610496000000",
    "number": "1154910230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 ATCHISON RD",
            "city": "SPRINGVILLE",
            "state": "TN",
            "postal_code": "382566455",
            "telephone_number": "731-363-0724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 W MAIN ST",
            "city": "WAVERLY",
            "state": "TN",
            "postal_code": "371851512",
            "telephone_number": "931-299-7378",
            "fax_number": "931-299-7399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZIMMERMAN",
        "first_name": "KRISTIE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-13",
        "last_updated": "2021-01-13",
        "certification_date": "2021-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "28102",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waverly, TN

Sources for this page

Verify at the official NPI Registry.