Active NPI
Premier Pediatrics of Memphis, PLLC
- Pediatrics Physician
- Lakeland, TN
National Provider Identifier
1235875576
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- Legal business name
- PREMIER PEDIATRICS OF MEMPHIS, PLLC
- Practice address
- 9160 Hwy 64
Ste 5
Lakeland, TN 38002 - Phone
- (901) 259-9200
- Fax
- (888) 494-2188
- NPI assigned
- May 10, 2022
- Last updated
- Jun 18, 2026
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Angela Marie Black
- Title
- Practice Administrator
- Phone
- (901) 259-9200
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | NU | Primary |
Addresses
Primary practice location
9160 Hwy 64
Ste 5
Lakeland, TN 38002
Mailing address
PO Box 248
Cordova, TN 38088-0248
National Provider Directory
National Provider DirectoryLocations
1250 N Germantown Pkwy
Ste 115
Cordova, TN 38016
Phone (901) 531-8555
4705 Elvis Presley Blvd
Ste 115
Memphis, TN 38116
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/IBAICD
Practitioners & affiliated clinicians
Practitioners 4
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Pediatrics Physician
- Cordova, TN
- NPI 1679776587
-
- Pediatric Nurse Practitioner
- West Memphis, AR
- NPI 1306249396
-
- Family Nurse Practitioner
- Columbus, MS
- NPI 1053047464
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1652140800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1781740800000",
"number": "1235875576",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 248",
"city": "CORDOVA",
"state": "TN",
"postal_code": "380880248"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9160 HWY 64",
"address_2": "STE 5",
"city": "LAKELAND",
"state": "TN",
"postal_code": "38002",
"telephone_number": "901-259-9200",
"fax_number": "888-494-2188"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PREMIER PEDIATRICS OF MEMPHIS, PLLC",
"organizational_subpart": "NO",
"enumeration_date": "2022-05-10",
"last_updated": "2026-06-18",
"certification_date": "2026-06-18",
"status": "A",
"authorized_official_last_name": "BLACK",
"authorized_official_first_name": "ANGELA",
"authorized_official_middle_name": "MARIE",
"authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
"authorized_official_telephone_number": "901-259-9200",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Lakeland, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.