NPIMap

Organization Active NPI

Healthy Life Clinic, Inc.

  • Family Nurse Practitioner
  • Knoxville, TN
National Provider Identifier
1437389731
Registry record updated Jan 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APN0000012264 Issued in TN
Legal business name
HEALTHY LIFE CLINIC, INC.
Practice address
110 Perimeter Park Rd.
Suite G
Knoxville, TN 37922-2200
Phone
(865) 247-6340
Fax
(865) 951-2617
NPI assigned
Jul 21, 2009
Last updated
Jan 27, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2012

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

Authorized official

Name
Mr. Gary R. Bickford, FNP-BCNPI 1700923331
Title
Owner
Phone
(865) 247-6340

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X APN0000012264 TN Primary

Addresses

Primary practice location

110 Perimeter Park Rd.
Suite G
Knoxville, TN 37922-2200

Mailing address

110 Perimeter Park Rd.
Suite G
Knoxville, TN 37922-2200
Phone (865) 247-6340

Other identifiers 1

IdentifierTypeStateIssuer
1517282MedicaidTN

National Provider Directory

National Provider Directory

Locations

110 Perimeter Park Rd
Knoxville, TN 37922
Phone (865) 247-6340

110 Perimeter Park Rd
Ste G
Knoxville, TN 37922
Phone (865) 247-6340

110 Perimeter Park Rd
Ste G
Knoxville, TN 37922
Phone (865) 247-6340

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1248134400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327622400000",
    "number": "1437389731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 PERIMETER PARK RD.",
            "address_2": "SUITE G",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379222200",
            "telephone_number": "865-247-6340",
            "fax_number": "865-951-2617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 PERIMETER PARK RD.",
            "address_2": "SUITE G",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379222200",
            "telephone_number": "865-247-6340",
            "fax_number": "865-951-2617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHY LIFE CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-21",
        "last_updated": "2012-01-27",
        "status": "A",
        "authorized_official_last_name": "BICKFORD",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "865-247-6340",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "FNP-BC"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "APN0000012264",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1517282",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Knoxville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2012; 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.