Leellon Louise Martin, NP

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

36006 Issued in TN

Practice address

5831 Port Haven Rd
Millington, TN 38053-8413

Phone

(901) 849-4108

NPI assigned

Apr 8, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Specialty

Nurse Practitioner

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kejac Ventures LLCGroup PAC ID 9335490325, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lmartin684517@direct.bmhcc.org

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.

• Kejac Ventures LLC

  • Internal Medicine Physician
  • Memphis, TN
  • NPI 1265919005
  Medicare reassignment Care Compare group NPD
• Southeastern Physician Services PC

  • Hospitalist Physician
  • Oak Ridge, TN
  • NPI 1083835441
  Medicare reassignment NPD
• Signify Health Medical Associates, PLLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1750845863

  TN

  Medicare reassignment NPD
• Kejac Ventures, PLLC,

  • Clinic/Center
  • Collierville, TN
  • NPI 1700779519
  NPD Authorized official

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

{
    "created_epoch": "1712534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785801600000",
    "number": "1386497865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5831 PORT HAVEN RD",
            "city": "MILLINGTON",
            "state": "TN",
            "postal_code": "380538413",
            "telephone_number": "901-849-4108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5831 PORT HAVEN RD",
            "city": "MILLINGTON",
            "state": "TN",
            "postal_code": "380538413",
            "telephone_number": "901-849-4108"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1501 Biscayne Blvd",
            "address_purpose": "LOCATION",
            "city": "Miami",
            "state": "FL",
            "postal_code": "331321449",
            "country_code": "US",
            "telephone_number": "877-870-0323",
            "fax_number": "866-427-3798",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "LEELLON",
        "middle_name": "LOUISE",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-04-08",
        "last_updated": "2026-08-04",
        "certification_date": "2026-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "TN",
            "license": "36006",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Luxottica of America Inc
• Alexander Joseph Mabile III
• Courtney Ann Makcen, CPNP
• Trent Wright Marcus, M.D.
• Carla Marsh, LPN
• Mary I Cates Landsee
• Kathy L McClain, DPH
• Geraldine Webber McCoy, MSN, APRN, FNP-C
• William L Medlock, HIPAA TAXONOMY 246Z0
• Melton Telepsychiatry Services

• Gerontology Nurse Practitioner in Millington, TN
• Providers in Millington, TN by specialty
• Gerontology Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.