Kathleen Wykoff

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

35209 Issued in TN

Practice address

400 N State of Franklin Rd
Johnson City, TN 37604-6035

Phone

(423) 431-6111

NPI assigned

Mar 28, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Erlanger Health

  • Internal Medicine Physician
  • Chattanooga, TN
  • NPI 1477256303

  Single Specialty

  Medicare reassignment NPD
• Erlanger Health

  • Durable Medical Equipment & Medical Supplies
  • Chattanooga, TN
  • NPI 1740073329
  NPD
• Chattanooga Hamilton County Hospital Authority

  • Internal Medicine Physician
  • Chattanooga, TN
  • NPI 1154751931

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1648425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702598400000",
    "number": "1174273478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 N STATE OF FRANKLIN RD",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376046035",
            "telephone_number": "423-431-6111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 N STATE OF FRANKLIN RD",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376046035",
            "telephone_number": "423-431-6111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYKOFF",
        "first_name": "KATHLEEN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-03-28",
        "last_updated": "2023-12-15",
        "certification_date": "2023-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Registered Nurse",
            "state": "TN",
            "license": "235803",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "TN",
            "license": "35209",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sydney Grace Wright
• Jennifer Rene Wyatt, M.S., BCBA, LBA
• Lauren Todt Wyatt, CRNP
• Wyche & Wyche, M.D., P.C.
• Donna Lee Wyche, MD
• Randolph Forbes Wykoff, MD, MPH&TM
• Ethan Wymer, RBT
• Tiffany L Yandell, NP
• Zhi Qiang Yao, MD
• John Benjamin Yarger, M.D.

• Pediatric Nurse Practitioner in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Pediatric Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.