Wade Family Medicine, LLC.

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

WADE FAMILY MEDICINE, LLC.

Doing business as

Wade Family Medicine

Practice address

899 Highway 51 S
Covington, TN 38019-2568

Phone

(901) 244-4646

Fax

(901) 244-4647

NPI assigned

Jan 16, 2018

Organization subpart

No

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

Authorized official

Name

Modeanna Leigh WadeNPI 1760767016

Title

FNP

Phone

(901) 244-4648

Specialties & licenses 5

Addresses

Other identifiers 1

Other names 1

• Wade Family Medicine Doing business as

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Practitioners 1

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

• Modeanna Leigh Wade, APRN

  • Family Nurse Practitioner
  • Covington, TN
  • NPI 1760767016
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1516060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720483200000",
    "number": "1629586375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 369",
            "city": "MILLINGTON",
            "state": "TN",
            "postal_code": "380830369",
            "telephone_number": "901-244-4648",
            "fax_number": "901-244-4647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "899 HIGHWAY 51 S",
            "city": "COVINGTON",
            "state": "TN",
            "postal_code": "380192568",
            "telephone_number": "901-244-4646",
            "fax_number": "901-244-4647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WADE FAMILY MEDICINE, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-16",
        "last_updated": "2024-07-09",
        "certification_date": "2024-07-09",
        "status": "A",
        "authorized_official_last_name": "WADE",
        "authorized_official_first_name": "MODEANNA",
        "authorized_official_middle_name": "LEIGH",
        "authorized_official_title_or_position": "FNP",
        "authorized_official_telephone_number": "901-244-4648"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "TN",
            "license": "16204",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "TN",
            "license": "16204",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1525986",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wade Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Wade Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Robyn Y. Vanderford, FNP
• Huy VI
• Carroll Logan Vincent, APN ,PMHNP- BC
• Dejo Viprakasit, MD
• Suttiwara Viprakasit, MD
• Modeanna Leigh Wade, APRN
• Wal-Mart Stores East LP
• Wal-Mart Stores East, LP
• Walgreen Co
• Walgreen Co

• Clinic/Center in Covington, TN
• Providers in Covington, 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 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.