Gibbs Family Practice, LLC
Organization Active NPI Family Nurse Practitioner · Corryton, TN
NPI 1457726374 · NPPES record last updated May 23, 2023
Key facts
- NPI
- 1457726374
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- APN17718 (TN)
- Legal business name
- GIBBS FAMILY PRACTICE, LLC
- Practice address
- 7331 Tazewell Pike
Corryton, TN 37721-3516 - Phone
- (865) 249-8044
- NPI assigned
- Dec 3, 2015
- Organization subpart
- No
Authorized official
- Name
- Mrs. Leslie Heiser, FNP
- Title
- Sole Member
- Phone
- (865) 249-8044
Practitioners 5
-
Amy Sexton Harrell, MSN, FNP-BC
-
Leslie Marie Heiser, FNP-BC
-
Maryjane Haney, MSN, FNP-C
-
Brian Gene Stanley, NP-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 44D2105050 | Gibbs Family Practice, LLC | Certificate of waiver | Nov 16, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160217000875 | TN | Part B Supplier - Clinic/Group Practice | 0446555122 |
Receives reassigned benefits from 3 practitioners Practice locations: Corryton, TN |
National Provider Directory
Locations
7331 Tazewell Pike
Corryton, TN 37721
Phone (865) 249-8044
Interoperability endpoints
- https://api.platform.athenahealth.com/12578/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner |
363LF0000X | APN17718 | TN | Yes |
Addresses
Primary practice location
7331 Tazewell Pike
Corryton, TN 37721-3516
Mailing address
7331 Tazewell Pike
Corryton, TN 37721-3516
Phone (865) 249-8044
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124450648 | Other | TN | INDIVIDUAL NPI |
| 1457726374 | Other | GROUP TYPE II NPI | |
| 1532504 | Medicaid | TN | |
| 3706725 | Other | TN | MCPTAN |
Other providers in Corryton, TN
- Family Medical Care Center, LLC
- Family Practice of Corryton
- Farmer Practice LLC
- Fast Pace Medical Clinic PLLC
- Kathie Ford
- Kendall Gigliotti
- Benjamin Craig Hamilton
- Maryjane Haney
- Amy Sexton Harrell
- Cindy Lou Harrison
All providers in Corryton, TN · Family Nurse Practitioner in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 23, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.