Pediatric Associates of West Tennessee PLLC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

PEDIATRIC ASSOCIATES OF WEST TENNESSEE PLLC

Practice address

1501 Brayton Ave
Dyersburg, TN 38024-3158

Phone

(731) 285-4111

NPI assigned

May 12, 2016

Organization subpart

No

Name

Jamie L EllerbrookNPI 1952623217

Title

Owner

Phone

(731) 285-4111

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

• Jamie L Ellerbrook, APN

  • Pediatric Nurse Practitioner
  • Dyersburg, TN
  • NPI 1952623217

  Pediatrics

  NPD (past) Authorized official
• Garine Lepejian, M.D.

  • Specialist
  • Dyersburg, TN
  • NPI 1043226897
  NPD (past)
• Samantha Lochridge, APN

  • Nurse Practitioner
  • Brownsville, TN
  • NPI 1093306342
  NPD (past)
• Anne Barret Richards, MSN, APRN, FNP-C

  • Pediatric Nurse Practitioner
  • Dyersburg, TN
  • NPI 1306552054

  Pediatrics

  NPD (past)
• Madison Wallace, APN

  • Family Nurse Practitioner
  • Covington, TN
  • NPI 1740703180

  Pediatrics

  NPD (past)
• Michelle Grace Puzdrakiewicz, M.D.

  • Pediatrics Physician
  • Jefferson, LA
  • NPI 1376526392
  NPD (past)

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Rural health clinic certification: CCN 448988

Legal name

PEDIATRIC ASSOCIATES OF WEST TENNESSEE PLLC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Dec 28, 2017

Last certification

Mar 5, 2026

Ownership / control type

1B

Organization structure

LLCProprietary

Enrollment address

1501 Brayton Ave
Dyersburg, TN 38024-3158

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 14, 2025.

{
    "created_epoch": "1463011200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747180800000",
    "number": "1679929285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 BRAYTON AVE",
            "city": "DYERSBURG",
            "state": "TN",
            "postal_code": "380243158",
            "telephone_number": "731-285-4111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 BRAYTON AVE",
            "city": "DYERSBURG",
            "state": "TN",
            "postal_code": "380243158",
            "telephone_number": "731-285-4111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC ASSOCIATES OF WEST TENNESSEE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-12",
        "last_updated": "2025-05-14",
        "certification_date": "2025-05-14",
        "status": "A",
        "authorized_official_last_name": "ELLERBROOK",
        "authorized_official_first_name": "JAMIE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "731-285-4111"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "TN",
            "license": null,
            "primary": true
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "TN",
            "license": "0000014756",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Drake Parker, DPT
• Misty M Parker, A.C.N.P.-B.C.
• Abbie Leigh Parnell
• Andreea Evelin Partal, M.D.
• Ravi Sanjay Patel, DDS
• Pediatric Associates, P.C.
• Aaron Pepito, PHARMD
• Ann Jannette R Pepito, PT
• Nerio Gomez Pepito, PT
• Phoenix Health and Wellness

• All providers in Dyersburg, TN
• Rural Health Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.