Individual provider Active NPI

Mechelle T Perry, CFNP

  • Nurse Practitioner
  • Medina, TN
National Provider Identifier
1225150667
Registry record updated Oct 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
105786 Issued in TN
Practice address
209 Grace CV
Medina, TN 38355-8785
Phone
(731) 783-0400
Fax
(731) 783-0402
NPI assigned
Apr 5, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 105786 TN Primary

Addresses

Primary practice location

209 Grace CV
Medina, TN 38355-8785

Mailing address

PO Box 100
Medina, TN 38355-0100
Phone (731) 783-0400

Other identifiers 2

IdentifierTypeStateIssuer
3902551MedicaidTN
4088128OtherBLUE CROSS BLUE SHIELD OF TN PIN

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
I20040206000519 TN Practitioner - Nurse Practitioner 4486547908 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Medina Family Medical Clinic, PCGroup PAC ID 9931161726, 3 clinicians

Practice addresses (Care Compare)

209 Grace Cove
Medina, TN 38355-8785
Phone (731) 783-0400

Hospital & facility affiliations

  • Jackson-Madison County General Hospital Hospital, Jackson, TN, CCN 440002
  • West Tennessee Healthcare Milan Hospital Hospital, Milan, TN, CCN 440060

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
105786TNMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Medina Family Medical Clinic PC CurrentSince Sep 7, 2004 Accepting new patients

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Medina Family Medical Clinic, PCMedina, TN, CCN 448996 Rural health clinic 5% Or Greater Direct Ownership Interest (50%)
Corporate Officer (50%)
W-2 Managing Employee (50%)
Operational/Managerial Control (50%)
Jul 8, 2004
Jul 8, 2004
Jul 8, 2004
Jul 8, 2004

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 1

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1175731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761782400000",
    "number": "1225150667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 100",
            "city": "MEDINA",
            "state": "TN",
            "postal_code": "383550100",
            "telephone_number": "731-783-0400",
            "fax_number": "731-783-0402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 GRACE CV",
            "city": "MEDINA",
            "state": "TN",
            "postal_code": "383558785",
            "telephone_number": "731-783-0400",
            "fax_number": "731-783-0402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERRY",
        "first_name": "MECHELLE",
        "middle_name": "T",
        "credential": "CFNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-05",
        "last_updated": "2025-10-30",
        "certification_date": "2025-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TN",
            "license": "105786",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3902551",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF TN PIN",
            "identifier": "4088128",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Medina, TN

Sources for this page

Verify at the official NPI Registry.