Organization Active NPI

Bluegrass Legacy Healthcare, PLLC

  • Primary Care Clinic/Center
  • Hendersonville, TN
National Provider Identifier
1467047258
Registry record updated May 28, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
BLUEGRASS LEGACY HEALTHCARE, PLLC
Practice address
105 Glen Oak Blvd Ste 202
Hendersonville, TN 37075-3058
Phone
(615) 826-2265
Fax
(615) 826-4616
NPI assigned
Mar 4, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 28, 2026

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

Authorized official

Name
Mrs. Abigail Joan Eubank, GNP, MSNNPI 1588861207
Title
Owner
Phone
(615) 826-2265

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Family Medicine) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207QG0300X
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

105 Glen Oak Blvd Ste 202
Hendersonville, TN 37075-3058

Mailing address

105 Glen Oak Blvd Ste 202
Hendersonville, TN 37075-3058
Phone (615) 826-2265

Other identifiers 1

IdentifierTypeStateIssuer
4112769OtherTNBCBST

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210513002696 TN Part B Supplier - Clinic/Group Practice 7618386020 Receives reassigned benefits from 1 practitioner
Practice locations: Hendersonville, TN

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D0950242Bluegrass Legacy Healthcare PLLC105 Glen Oak Blvd #202, Hendersonville, TN 37075Certificate of waiverAug 20, 2026

National Provider Directory

National Provider Directory

Locations

353 New Shackle Island Rd
Ste 245C
Hendersonvlle, TN 37075
Phone (615) 826-2265

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1614816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779926400000",
    "number": "1467047258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 GLEN OAK BLVD STE 202",
            "city": "HENDERSONVILLE",
            "state": "TN",
            "postal_code": "370753058",
            "telephone_number": "615-826-2265",
            "fax_number": "615-826-4616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 GLEN OAK BLVD STE 202",
            "city": "HENDERSONVILLE",
            "state": "TN",
            "postal_code": "370753058",
            "telephone_number": "615-826-2265",
            "fax_number": "615-826-4616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUEGRASS LEGACY HEALTHCARE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-04",
        "last_updated": "2026-05-28",
        "certification_date": "2026-05-28",
        "status": "A",
        "authorized_official_last_name": "EUBANK",
        "authorized_official_first_name": "ABIGAIL",
        "authorized_official_middle_name": "JOAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "615-826-2265",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "GNP, MSN"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBST",
            "identifier": "4112769",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hendersonville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.