Individual provider Active NPI

Michael Damron, APRN

  • Family Nurse Practitioner
  • Morristown, TN
National Provider Identifier
1619360773
Registry record updated May 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
31164 Issued in TN
Practice address
291 S Daisy St
Morristown, TN 37813-2362
Phone
(423) 616-8315
Fax
(423) 616-8316
NPI assigned
Mar 13, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 5, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 3009277 KY
Family Nurse Practitioner 363LF0000X 31164 TN Primary

Addresses

Primary practice location

291 S Daisy St
Morristown, TN 37813-2362

Mailing address

291 S Daisy St
Morristown, TN 37813-2362
Phone (423) 616-8315

Other practice location 1

1138 Lexington Rd
Suite 290
Georgetown, KY 40324-9672
Phone (502) 863-0721

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220511001177 TN Practitioner - Nurse Practitioner 1254659634 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
31164TNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Fast Pace Medical Clinic PLLC CurrentSince Apr 27, 2022 Accepting new patients
Fast Pace Medical Clinic PLLC CurrentSince Apr 27, 2022 Accepting new patients
Commonhealth LLC PastSince Aug 18, 2020 Accepting new patients

Locations

291 S Daisy St
Morristown, TN 37813
Phone (423) 616-8315

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1426204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651708800000",
    "number": "1619360773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "291 S DAISY ST",
            "city": "MORRISTOWN",
            "state": "TN",
            "postal_code": "378132362",
            "telephone_number": "423-616-8315",
            "fax_number": "423-616-8316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "291 S DAISY ST",
            "city": "MORRISTOWN",
            "state": "TN",
            "postal_code": "378132362",
            "telephone_number": "423-616-8315",
            "fax_number": "423-616-8316"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1138 Lexington Rd",
            "address_2": "Suite 290",
            "address_purpose": "LOCATION",
            "city": "Georgetown",
            "state": "KY",
            "postal_code": "403249672",
            "country_code": "US",
            "telephone_number": "502-863-0721",
            "fax_number": "502-863-6104",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAMRON",
        "first_name": "MICHAEL",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-03-13",
        "last_updated": "2022-05-05",
        "certification_date": "2022-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "3009277",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "31164",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Morristown, TN

Sources for this page

Verify at the official NPI Registry.