Longevity Clinical LTC Associates of Tennessee, PLLC

Primary specialty

Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X

Legal business name

LONGEVITY CLINICAL LTC ASSOCIATES OF TENNESSEE, PLLC

Practice address

309 Main St
Red Boiling Springs, TN 37150-2149

Phone

(615) 699-2238

NPI assigned

Aug 6, 2024

Last updated

Aug 6, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Diane Vincur, PRACTICE MANAGER

Title

Practice Manager

Phone

(561) 815-2427

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Practitioners 9

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.

• Katelyn Berman, NP

  • Gerontology Nurse Practitioner
  • Nashville, TN
  • NPI 1952851784
  Medicare reassignment NPD
• April Michelle Davidson, ACNS

  • Adult Health Clinical Nurse Specialist
  • Paris, TN
  • NPI 1629445119
  Medicare reassignment NPD
• Michelle Elizabeth Farrey, NP

  • Family Nurse Practitioner
  • Brentwood, TN
  • NPI 1861053472
  Medicare reassignment NPD
• Jordan Ryan Kilgore, RN, AGACNP-BC

  • Acute Care Nurse Practitioner
  • Dunlap, TN
  • NPI 1962185686

  Gerontology

  Medicare reassignment NPD
• Sheila Lynn Yokley, APN

  • Family Nurse Practitioner
  • Brentwood, TN
  • NPI 1558540666
  Medicare reassignment NPD
• Desiree Albritton, APRN

  • Family Nurse Practitioner
  • Paducah, KY
  • NPI 1023550761

  TN

  Medicare reassignment NPD
• Kishana Renee Bell, FNP-C

  • Family Nurse Practitioner
  • Olive Branch, MS
  • NPI 1881181634

  TN

  Medicare reassignment NPD
• Gradaphene I Hayden, FNP-C

  • Family Nurse Practitioner
  • Scottsville, KY
  • NPI 1649929811

  TN

  Medicare reassignment NPD
• Endia Cherese Johnson-Pitts, MD

  • Hospitalist Physician
  • Winston Salem, NC
  • NPI 1801819594
  NPD (past)

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

{
    "created_epoch": "1722902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722902400000",
    "number": "1326878299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11780 US HIGHWAY 1 STE N107",
            "city": "NORTH PALM BEACH",
            "state": "FL",
            "postal_code": "334083007",
            "telephone_number": "561-815-2427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 MAIN ST",
            "city": "RED BOILING SPRINGS",
            "state": "TN",
            "postal_code": "371502149",
            "telephone_number": "615-699-2238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONGEVITY CLINICAL LTC ASSOCIATES OF TENNESSEE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-06",
        "last_updated": "2024-08-06",
        "certification_date": "2024-08-06",
        "status": "A",
        "authorized_official_last_name": "VINCUR",
        "authorized_official_first_name": "DIANE",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "561-815-2427",
        "authorized_official_credential": "PRACTICE MANAGER"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Renae Guffey
• Clifton Lee Hackett, A.A.S.
• Jessica Faylene McGee Hagan, RBT
• Benita Gail Hudson, MSOTR/L, PTA
• Lanny R Hudson, D PH
• Macon Care Center LLC
• Martin Family Healthcare LLC.
• Eric Justin McGriff, PTA
• Amanda Lynn Mitchell, RN
• Palace RBS LLC (The Palace Health Care and Rehabilitation Center)

• Geriatric Medicine (Family Medicine) Physician in Red Boiling Springs, TN
• Providers in Red Boiling Springs, TN by specialty
• Geriatric Medicine (Family Medicine) Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 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.