Individual provider Active NPI

Jerry Coleman II, N.P

  • Nurse Practitioner
  • Cleveland, TN
National Provider Identifier
1629483607
Registry record updated Jun 27, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
18803 Issued in TN
Practice address
2305 Chambliss Ave NW
Cleveland, TN 37311-3847
Phone
(423) 559-6000
NPI assigned
Jun 27, 2014
Last updated
Jun 27, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 18803 TN Primary

Addresses

Primary practice location

2305 Chambliss Ave NW
Cleveland, TN 37311-3847

Mailing address

2305 Chambliss Ave NW
Cleveland, TN 37311-3847
Phone (423) 559-6000

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
I20141020001457 TN Practitioner - Nurse Practitioner 7012138886 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
18803TNMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
App of Tennessee Ed, PLLC Nurse Practitioner CurrentSince Nov 11, 2019 Accepting new patients
Southeastern Emergency Services P C Nurse Practitioner CurrentSince Aug 1, 2014 Accepting new patients

Locations

2305 Chambliss Ave NW
Cleveland, TN 37311
Phone (423) 559-6000

106 Medical Center Blvd
Fayetteville, TN 37334
Phone (931) 438-1100

1900 N Winston Rd
Ste 300
Knoxville, TN 37919
Phone (865) 271-6000

550 Fort Loudoun Med Center Dr
Lenoir City, TN 37772
Phone (865) 271-6000

907 Lamar Alexander Pkwy
Maryville, TN 37804
Phone (865) 766-8818

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1403827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403827200000",
    "number": "1629483607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2305 CHAMBLISS AVE NW",
            "city": "CLEVELAND",
            "state": "TN",
            "postal_code": "373113847",
            "telephone_number": "423-559-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2305 CHAMBLISS AVE NW",
            "city": "CLEVELAND",
            "state": "TN",
            "postal_code": "373113847",
            "telephone_number": "423-559-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLEMAN",
        "first_name": "JERRY",
        "name_suffix": "II",
        "credential": "N.P",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-27",
        "last_updated": "2014-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TN",
            "license": "18803",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cleveland, TN

Sources for this page

Verify at the official NPI Registry.