Fountain of Youth Medical LLC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

Legal business name

FOUNTAIN OF YOUTH MEDICAL LLC

Practice address

135 Lovell Rd
Knoxville, TN 37934-1904

Phone

(865) 392-1400

Fax

(865) 392-1402

NPI assigned

Dec 17, 2018

Organization subpart

No

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

Authorized official

Name

Geneva Lynne Worthington, FNP-CNPI 1558843235

Title

FNP-C

Phone

(865) 392-1500

Specialties & licenses 1

Addresses

Locations

Practitioners 2

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

• Geneva Lynne Worthington, NURSE PRACTITIONER

  • Family Medicine Physician
  • Knoxville, TN
  • NPI 1558843235
  NPD (past) Authorized official
• Timothy Alan Fox, N.P.

  • Family Nurse Practitioner
  • Knoxville, TN
  • NPI 1437158961
  NPD (past)

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

{
    "created_epoch": "1545004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1551830400000",
    "number": "1396216339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "135 LOVELL RD",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379341904",
            "telephone_number": "865-392-1500",
            "fax_number": "865-392-1402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 LOVELL RD",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379341904",
            "telephone_number": "865-392-1400",
            "fax_number": "865-392-1402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUNTAIN OF YOUTH MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-17",
        "last_updated": "2019-03-06",
        "status": "A",
        "authorized_official_last_name": "WORTHINGTON",
        "authorized_official_first_name": "GENEVA",
        "authorized_official_middle_name": "LYNNE",
        "authorized_official_title_or_position": "FNP-C",
        "authorized_official_telephone_number": "865-392-1500",
        "authorized_official_credential": "FNP-C"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fountain City Chiropractic Clinic
• Fountain City Dental Care
• Fountain City Endodontics, PLLC
• Fountain City Smiles PLLC
• Fountain of Youth LLC
• Four Way Prescription Shop
• Dana Ronald Foust, DDS
• Doby Foust Jr.
• Janiece Ren'Ee-Lemaster Foust, LCSW
• Rachael M. Foust, PA-C

• Nurse Practitioner in Knoxville, TN
• Providers in Knoxville, TN by specialty
• Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2019; 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.