Primary Care Clinic of Jackson

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

000896897 Issued in TN

Legal business name

PRIMARY CARE CLINIC OF JACKSON

Practice address

54 Exeter Rd Ste B
Jackson, TN 38305-1985

Phone

(731) 935-9463

NPI assigned

Apr 5, 2017

Organization subpart

No

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

Authorized official

Name

Kathy Michelle O'Connor-Wray, DNP, APN, FNP-C

Title

FNP, Owner

Phone

(731) 265-6197

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Locations

Change-of-ownership history 1

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

• Family Medical Clinic of Trezevant

  • Rural Health Clinic/Center
  • Trezevant, TN
  • NPI 1538703897

  Sold to, 2019-11-19

  CMS change of ownership

Practitioners 2

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

• Nichcole Rau, NP

  • Family Nurse Practitioner
  • Jackson, TN
  • NPI 1891330817
  NPD (past)
• Holly Michelle Sanders, NP

  • Family Nurse Practitioner
  • Jackson, TN
  • NPI 1437674918
  NPD (past)

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

{
    "created_epoch": "1491350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1609309855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8 STONEBRIDGE BLVD STE M",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383052178",
            "telephone_number": "731-265-6197",
            "fax_number": "731-265-6198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "54 EXETER RD STE B",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383051985",
            "telephone_number": "731-935-9463"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8 Stonebridge Blvd Ste M",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "TN",
            "postal_code": "383052178",
            "country_code": "US",
            "telephone_number": "731-265-6197",
            "fax_number": "731-265-6198",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PRIMARY CARE CLINIC OF JACKSON",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-05",
        "last_updated": "2022-07-21",
        "certification_date": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "O'CONNOR-WRAY",
        "authorized_official_first_name": "KATHY",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "FNP, OWNER",
        "authorized_official_telephone_number": "731-265-6197",
        "authorized_official_credential": "DNP, APN, FNP-C"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "TN",
            "license": "000896897",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katie Beth Price-Verdell, PSY.D.
• James Alfred Price Jr., MD
• William Bradford Priester, M.D.
• Primary Care - Bemis, LLC
• Primary Care - South Limited
• Primary Care of Bemis & Associates, PLLC
• Primary Care Specialists of West Tennessee, LLC
• Primary Care Specialists South PLLC
• Alexandria Hearn Prince, FNP-C
• Emily Privitt

• Clinic/Center in Jackson, TN
• Providers in Jackson, TN by specialty
• Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.