Active NPI
Jennifer Keele Nogodula, P.T.
- Physical Therapist
- McMinnville, TN
National Provider Identifier
1508913153
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 7062
- Practice address
- 928 Old Smithville Rd
MC Minnville, TN 37110-6805 - Phone
- (931) 473-8431
- NPI assigned
- Jan 5, 2007
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 7062 | TN | Primary |
Addresses
Primary practice location
928 Old Smithville Rd
MC Minnville, TN 37110-6805
Mailing address
328 Riddle Rd
Manchester, TN 37355
Phone (931) 728-9192
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7062 | TN | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167955200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1508913153",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "328 RIDDLE RD",
"city": "MANCHESTER",
"state": "TN",
"postal_code": "37355",
"telephone_number": "931-728-9192"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "928 OLD SMITHVILLE RD",
"city": "MC MINNVILLE",
"state": "TN",
"postal_code": "371106805",
"telephone_number": "931-473-8431"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NOGODULA",
"first_name": "JENNIFER",
"middle_name": "KEELE",
"name_prefix": "Mrs.",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TN",
"license": "7062",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in McMinnville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.