Individual provider Active NPI

Christine Corpuz Kowal, FNP-BC

  • Family Nurse Practitioner
  • Lebanon, TN
National Provider Identifier
1417296807
Registry record updated Apr 26, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
17209 Issued in TN
Practice address
1407 W Baddour Pkwy
Lebanon, TN 37087-2513
Phone
(615) 444-6203
Fax
(615) 444-6252
NPI assigned
Feb 5, 2013
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 26, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 17209 TN Primary

Addresses

Primary practice location

1407 W Baddour Pkwy
Lebanon, TN 37087-2513

Mailing address

1407 W Baddour Pkwy
Lebanon, TN 37087-2513
Phone (615) 444-6203

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
I20130618000700 TN Practitioner - Nurse Practitioner 4486893724 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fast Pace Medical Clinic PLLCGroup PAC ID 5395881841, 737 clinicians

Practice addresses (Care Compare)

9002 Sparta Pike
Watertown, TN 37184-1427
Phone (931) 253-1110

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
17209TNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Fast Pace Medical Clinic PLLC CurrentSince Jan 7, 2021 Accepting new patients
Anycare LLC CurrentSince May 2, 2014 Accepting new patients
Fast Pace Medical Clinic PLLC CurrentSince Jan 7, 2021 Accepting new patients
Upperline Healthcare, PC CurrentSince Nov 1, 2025 Accepting new patients
Upperline Healthcare, PC CurrentSince Nov 1, 2025 Accepting new patients

Locations

7348 E Brainerd Rd
Chattanooga, TN 37421
Phone (205) 822-8038

718 E College St
Dickson, TN 37055
Phone (615) 560-7016

1128 N Castle Heights Ave
Lebanon, TN 37087
Phone (423) 352-4381

702 S Cumberland St
Lebanon, TN 37087
Phone (615) 444-2121

1307 N Ellington Pkwy
Lewisburg, TN 37091
Phone (931) 359-4555

931 Old Smithville Rd
McMinnville, TN 37110
Phone (931) 259-4144

235 Highway 52 W
Portland, TN 37148
Phone (615) 802-1087

1420 W College St
Pulaski, TN 38478
Phone (931) 363-3004

3813 Old Port Royal Rd N
Spring Hill, TN 37174
Phone (931) 487-1006

910 New Highway 68
Sweetwater, TN 37874
Phone (423) 836-9304

9002 Sparta Pike
Watertown, TN 37184
Phone (615) 697-6836

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1360022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1366934400000",
    "number": "1417296807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1407 W BADDOUR PKWY",
            "city": "LEBANON",
            "state": "TN",
            "postal_code": "370872513",
            "telephone_number": "615-444-6203",
            "fax_number": "615-444-6252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1407 W BADDOUR PKWY",
            "city": "LEBANON",
            "state": "TN",
            "postal_code": "370872513",
            "telephone_number": "615-444-6203",
            "fax_number": "615-444-6252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOWAL",
        "first_name": "CHRISTINE",
        "middle_name": "CORPUZ",
        "name_prefix": "Mrs.",
        "credential": "FNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-02-05",
        "last_updated": "2013-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "17209",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lebanon, TN

Sources for this page

Verify at the official NPI Registry.