Individual provider Active NPI

Kaylee Woodall Mayberry, PA-C

  • Physician Assistant
  • Gallatin, TN
National Provider Identifier
1417524273
Registry record updated Oct 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5221 Issued in TN
Practice address
225 Big Station Camp Blvd
Gallatin, TN 37066-8464
Phone
(615) 328-3400
NPI assigned
Jun 9, 2021
Last updated
Oct 9, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5221 TN Primary

Addresses

Primary practice location

225 Big Station Camp Blvd
Gallatin, TN 37066-8464

Mailing address

225 Big Station Camp Blvd Ste 206
Gallatin, TN 37066-8466

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
I20230405001511 TN Practitioner - Physician Assistant 2860867801 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sumner Physician Practices LLCGroup PAC ID 8820283260, 59 clinicians

Practice addresses (Care Compare)

1531 Hunt Club Blvd
Suite 304
Gallatin, TN 37066-6098
Phone (615) 328-3750

225 Big Station Camp Blvd
Gallatin, TN 37066-8466

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Sumner Physician Practices LLC CurrentSince Mar 19, 2023 Accepting new patients
Sumner Physician Practices, LLC CurrentSince Mar 19, 2023 Accepting new patients
Trevecca Nazarene University PastSince Jun 1, 2021 Accepting new patients
Sumner Physician Practices LLC PastSince Dec 1, 2019 Accepting new patients
Sumner Physician Practices LLC Past Accepting new patients

Locations

330 Seven Springs Way
Brentwood, TN 37027
Phone (615) 920-7780

225 Big Station Camp Blvd
Gallatin, TN 37066
Phone (615) 328-3380

225 Big Station Camp Blvd
Ste 206
Gallatin, TN 37066
Phone (615) 328-3400

225 Big Station Camp Blvd
Ste 211
Gallatin, TN 37066
Phone (615) 328-3480

Interoperability endpoints

  • Direct secure messaging: kaylee.mayberry.1@19363.direct.athenahealth.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1623196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759968000000",
    "number": "1417524273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 BIG STATION CAMP BLVD STE 206",
            "city": "GALLATIN",
            "state": "TN",
            "postal_code": "370668466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 BIG STATION CAMP BLVD",
            "city": "GALLATIN",
            "state": "TN",
            "postal_code": "370668464",
            "telephone_number": "615-328-3400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAYBERRY",
        "first_name": "KAYLEE",
        "middle_name": "WOODALL",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-09",
        "last_updated": "2025-10-09",
        "certification_date": "2025-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "5221",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gallatin, TN

Sources for this page

Verify at the official NPI Registry.