Tiffany Persons

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

2020023579 Issued in MO

Practice address

2400 Lucy Lee Pkwy Ste a
Poplar Bluff, MO 63901-2427

Phone

(573) 686-1144

Fax

(573) 686-3312

NPI assigned

Jul 31, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1596153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596153600000",
    "number": "1558971937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 LUCY LEE PKWY STE A",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639012427",
            "telephone_number": "573-686-1144",
            "fax_number": "573-686-3312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 LUCY LEE PKWY STE A",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639012427",
            "telephone_number": "573-686-1144",
            "fax_number": "573-686-3312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERSONS",
        "first_name": "TIFFANY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-07-31",
        "last_updated": "2020-07-31",
        "certification_date": "2020-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2020023579",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MISSOURI LICENSE",
            "identifier": "2020023579",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Mail",
            "affiliation": "N",
            "address_1": "2400 Lucy Lee Pkwy Ste A",
            "city": "Poplar Bluff",
            "state": "MO",
            "country_code": "US",
            "postal_code": "639012427",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Amy Michelle Pennington, NP
• Stefanie Sue Pennington, LPN
• Theresa Louise Pennington, FNP-BC
• Timothy Paul Pennington, LCSW
• Julia Leeann Perryman
• Richard Pestillos, PT
• Rebecca Peters
• Janessia Chenelle Pettigrew, APRN, PMHNP-BC
• Suwan Phanijphand, MD
• Astasia Estell Phelps

• Family Nurse Practitioner in Poplar Bluff, MO
• Providers in Poplar Bluff, MO by specialty
• Family Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.