Courtney Faught, APN
Individual provider Active NPI Nurse Practitioner · Tiptonville, TN
NPI 1457789380 · NPPES record last updated Jul 15, 2023
Key facts
- NPI
- 1457789380
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- APN0000017625 (TN)
- Practice address
- 710 Carl Perkins Pkwy
Tiptonville, TN 38079-1678 - Phone
- (731) 253-6690
- Fax
- (731) 253-6692
- NPI assigned
- Nov 1, 2013
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Total Extended Care Services PC
Practice addresses (Care Compare)
616 W Forest Ave
Jackson, TN 38301-3902
Phone (731) 574-3000
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140520000572 | TN | Practitioner - Nurse Practitioner | 2961625934 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Total Extended Care Services PC | Current |
Accepting new patients | |
| Bluff City Pain, PLLC | Past |
Accepting new patients | |
| Premier Wound Care, PLLC | Nurse Practitioner | Past |
Accepting new patients |
Locations
18312 Middlebelt Rd
Livonia, MI 48152
Phone (248) 426-9944
616 W Forest Ave
Jackson, TN 38301
Phone (731) 422-0330
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | APN0000017625 | TN | Yes |
Addresses
Primary practice location
710 Carl Perkins Pkwy
Tiptonville, TN 38079-1678
Mailing address
1720 E Reelfoot Ave Ste 200
Union City, TN 38261-6049
Phone (731) 507-0272
Other practice location 1
1034 Reelfoot St
Tiptonville, TN 38079-1607
Phone (731) 394-1145
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| Q005152 | Medicaid | TN |
Other providers in Tiptonville, TN
- Citizens of Lake County for Health Care Inc
- Amanda Collins
- County of Lake
- Kristen Deaton
- Kerri A Ervin
- Colton Edward Gramse
- Carol Winfred Guess
- Norma Jean Johnson
- Courtney Kent
- Terra Micah King
All providers in Tiptonville, TN · 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 Jul 15, 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.
- Order and Referring (CMS).
- 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.