Serena Proudfoot, FNP-C
Individual provider Active NPI Family Nurse Practitioner · Ardmore, TN
NPI 1497417232 · NPPES record last updated Nov 29, 2022
Key facts
- NPI
- 1497417232
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 31302 (TN)
- Practice address
- 26150 Main St
Ardmore, TN 38449-3158 - Phone
- (931) 207-9297
- Fax
- (931) 209-9298
- NPI assigned
- Oct 8, 2021
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
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 |
|---|---|---|---|---|
| I20220706003975 | TN | Practitioner - Nurse Practitioner | 1254711310 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| F09211477 | AL | MD | Family Nurse Practitioner |
| 31302 | TN | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fast Pace Medical Clinic PLLC | Current |
Accepting new patients | |
| Celebration Family Care PLLC | Current |
Accepting new patients | |
| Fast Pace Medical Clinic PLLC | Current |
Accepting new patients |
Locations
26150 Main St
Ardmore, TN 38449
Phone (931) 202-9297
529 W Commerce St
Lewisburg, TN 37091
Phone (931) 270-9729
Interoperability endpoints
- serena.proudfoot.1@3755.direct.athenahealth.com
- https://api.platform.athenahealth.com/3755/brand/2/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 31302 | TN | Yes |
| Family Nurse Practitioner | 363LF0000X | F09211477 | AL |
Addresses
Primary practice location
26150 Main St
Ardmore, TN 38449-3158
Mailing address
26150 Main St
Ardmore, TN 38449-3158
Phone (931) 207-9297
Other practice location 1
13173 Hidden Valley Dr
Madison, AL 35756-3167
Phone (256) 542-1574
Other providers in Ardmore, TN
- Jennifer Leatherwood
- Matthew P. McMasters,DDS,PC
- Melissa Hammel Consulting
- Tamara Moody
- Madison Hughes Plunkett
- Olivia Christine Rathgeb
- Results-Ast JV, LLC
- Bayleigh Ahna Robbins
- Makayla Smith
- Joanna Marie Sneed
All providers in Ardmore, 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 Nov 29, 2022. 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.