Organization Active NPI

Harrogate Family Practice

  • Nurse Practitioner
  • Harrogate, TN
National Provider Identifier
1417119595
Registry record updated Jul 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
APN0000007778 Issued in TN
Legal business name
HARROGATE FAMILY PRACTICE
Practice address
6976 Cumberland Gap Pkwy
Harrogate, TN 37752-8230
Phone
(423) 869-3332
Fax
(423) 869-2064
NPI assigned
Jun 30, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2008

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

Authorized official

Name
Mrs. Amanda Brown, APRNNPI 1104941053
Title
Owner
Phone
(423) 869-3332

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363L00000X APN0000007778 TN Primary

Addresses

Primary practice location

6976 Cumberland Gap Pkwy
Harrogate, TN 37752-8230

Mailing address

6976 Cumberland Gap Pkwy
Harrogate, TN 37752-8230
Phone (423) 869-3332

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080719000043 TN Part B Supplier - Clinic/Group Practice 0840363123 Receives reassigned benefits from 3 practitioners
Practice locations: Harrogate, TN

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D1082302Harrogate Family Practice6976 Cumberland Gap Pkwy, Harrogate, TN 37752Certificate of waiverApr 3, 2028

National Provider Directory

National Provider Directory

Locations

617 E Central Ave
La Follette, TN 37766
Phone (423) 201-9799

Practitioners & affiliated clinicians

Practitioners 12

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

NPI Registry JSON

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

{
    "created_epoch": "1214784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217289600000",
    "number": "1417119595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6976 CUMBERLAND GAP PKWY",
            "city": "HARROGATE",
            "state": "TN",
            "postal_code": "377528230",
            "telephone_number": "423-869-3332",
            "fax_number": "423-869-2064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6976 CUMBERLAND GAP PKWY",
            "city": "HARROGATE",
            "state": "TN",
            "postal_code": "377528230",
            "telephone_number": "423-869-3332",
            "fax_number": "423-869-2064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARROGATE FAMILY PRACTICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-30",
        "last_updated": "2008-07-29",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "423-869-3332",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": "TN",
            "license": "APN0000007778",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Harrogate, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.