Organization Active NPI

Neuro Institute of East Tennessee, PLLC

  • Psychologist
  • Knoxville, TN
National Provider Identifier
1306614466
Registry record updated Jan 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
NEURO INSTITUTE OF EAST TENNESSEE, PLLC
Practice address
409 Montbrook LN
Knoxville, TN 37919-2704
Phone
(865) 556-0537
NPI assigned
Dec 18, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2024

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

Authorized official

Name
Dr. Nichole Miller, PSYDNPI 1194259036
Title
Psychologist
Phone
(865) 556-0537

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103T00000X Primary

Addresses

Primary practice location

409 Montbrook LN
Knoxville, TN 37919-2704

Mailing address

437 Highland Hills Rd
Knoxville, TN 37919-4211
Phone (865) 556-0537

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240105002592 TN Part B Supplier - Clinic/Group Practice 0042661878 Receives reassigned benefits from 1 practitioner
Practice locations: Knoxville, TN

National Provider Directory

National Provider Directory

Locations

409 Montbrook Ln
Knoxville, TN 37919
Phone (865) 224-8867

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1702857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704326400000",
    "number": "1306614466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "437 HIGHLAND HILLS RD",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379194211",
            "telephone_number": "865-556-0537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "409 MONTBROOK LN",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379192704",
            "telephone_number": "865-556-0537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEURO INSTITUTE OF EAST TENNESSEE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-18",
        "last_updated": "2024-01-04",
        "certification_date": "2024-01-04",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "NICHOLE",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "865-556-0537",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Knoxville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.