Individual provider Active NPI

Ivy N Harden, FNP-BC

  • Family Nurse Practitioner
  • Mountain Home, TN
National Provider Identifier
1366756967
Registry record updated Jul 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
15095 Issued in TN
Practice address
PO Box 4000
Mountain Home, TN 37684-4000
Phone
(865) 573-0698
Fax
(865) 573-3174
NPI assigned
Aug 6, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X RN106158 TN
Family Nurse Practitioner 363LF0000X 15095 TN Primary

Addresses

Primary practice location

PO Box 4000
Mountain Home, TN 37684-4000

Mailing address

PO Box 4000
Johnson City, TN 37602-4000
Phone (800) 355-3565

Other names 1

  • Ms. Ivy N Whaley Former name

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
I20220824000934 TN Order and Referring Only - Nurse Practitioner 6305030685

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
RN106158TNMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Cherokee Health Systems Past Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1281052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658188800000",
    "number": "1366756967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4000",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376024000",
            "telephone_number": "800-355-3565",
            "fax_number": "423-714-2355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PO BOX 4000",
            "city": "MOUNTAIN HOME",
            "state": "TN",
            "postal_code": "376844000",
            "telephone_number": "865-573-0698",
            "fax_number": "865-573-3174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARDEN",
        "first_name": "IVY",
        "middle_name": "N",
        "name_prefix": "Mrs.",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-06",
        "last_updated": "2022-07-19",
        "certification_date": "2022-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TN",
            "license": "RN106158",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "15095",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "IVY",
            "last_name": "WHALEY",
            "middle_name": "N",
            "prefix": "MS.",
            "credential": "FNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Mountain Home, TN

Sources for this page

Verify at the official NPI Registry.