Individual provider Active NPI

Karen Crain Mitchell, NP

  • Gerontology Nurse Practitioner
  • Maryville, TN
National Provider Identifier
1407910227
Registry record updated Nov 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
175935 Issued in CO
Practice address
252 Cherokee Professional Park
Maryville, TN 37804-5153
Phone
(865) 980-5200
Fax
(865) 246-2106
NPI assigned
Dec 20, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 175935 CO Primary

Addresses

Primary practice location

252 Cherokee Professional Park
Maryville, TN 37804-5153

Mailing address

PO Box 5777
Maryville, TN 37802-5777
Phone (865) 246-2104

Other identifiers 1

IdentifierTypeStateIssuer
09177361MedicaidCO

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
I20160920002964 TN Practitioner - Nurse Practitioner 9032359450 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
175935COMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Diagnostic Imaging, PC CurrentSince Oct 3, 2018 Accepting new patients
Advanced Diagnostic Imaging PC CurrentSince Oct 3, 2018 Accepting new patients
Inpatient Consultants of Colorado, PC Past Accepting new patients
Housecall Primary Care, PLLC PastSince Nov 1, 2019 Accepting new patients
Inpatient Consultants of Colorado PC Past Accepting new patients
Abundance Health Care PastSince Jul 1, 2015 Accepting new patients

Locations

1642 Westgate Cir
Ste 202
Brentwood, TN 37027
Phone (615) 838-3845

3024 Business Park Cir
Goodlettsvlle, TN 37072
Phone (615) 239-2018

3443 Dickerson Pike
Ste 400
Nashville, TN 37207
Phone (615) 612-2146

Organizations & group practices 6

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": "1166572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574726400000",
    "number": "1407910227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5777",
            "city": "MARYVILLE",
            "state": "TN",
            "postal_code": "378025777",
            "telephone_number": "865-246-2104",
            "fax_number": "865-246-2106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "252 CHEROKEE PROFESSIONAL PARK",
            "city": "MARYVILLE",
            "state": "TN",
            "postal_code": "378045153",
            "telephone_number": "865-980-5200",
            "fax_number": "865-246-2106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "KAREN",
        "middle_name": "CRAIN",
        "name_prefix": "Ms.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-20",
        "last_updated": "2019-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "CO",
            "license": "175935",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09177361",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Maryville, TN

Sources for this page

Verify at the official NPI Registry.