Organization Active NPI

Premier Pediatrics of Memphis, PLLC

  • Pediatrics Physician
  • Lakeland, TN
National Provider Identifier
1235875576
Registry record updated Jun 18, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
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, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2026

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)CodeLicenseStatePrimary
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 Directory

Locations

1250 N Germantown Pkwy
Ste 115
Cordova, TN 38016
Phone (901) 531-8555

4705 Elvis Presley Blvd
Ste 115
Memphis, TN 38116

Interoperability endpoints

  • FHIR API: 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.

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.

Verify at the official NPI Registry.