Integrated Facial Aesthetics, PLLC

Primary specialty

Otolaryngology/Facial Plastic Surgery PhysicianTaxonomy code 207YX0905X

Legal business name

INTEGRATED FACIAL AESTHETICS, PLLC

Practice address

1821 N Washington St
Tullahoma, TN 37388-2221

Phone

(931) 455-2005

Fax

(931) 455-4450

NPI assigned

Feb 11, 2026

Last updated

Feb 11, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tracy Hickerson

Title

Credentialing Facilitator

Phone

(931) 461-5056

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jordan Licata, DO

  • Otolaryngology Physician
  • Tullahoma, TN
  • NPI 1952795106
  Medicare reassignment NPD
• Michael R Cruz, CRNA

  • Certified Registered Nurse Anesthetist
  • McMinnville, TN
  • NPI 1740364033
  Medicare reassignment
• Michael Feltz, PA

  • Physician Assistant
  • Tullahoma, TN
  • NPI 1902139058
  Medicare reassignment
• Kelly V Lawson, CRNA

  • Certified Registered Nurse Anesthetist
  • Nashville, TN
  • NPI 1356384085
  Medicare reassignment
• Lonnie Scholl, PA-C

  • Physician Assistant
  • Tullahoma, TN
  • NPI 1043264575
  Medicare reassignment
• Jennifer Rae Chambers, CRNA

  • Certified Registered Nurse Anesthetist
  • Beaumont, TX
  • NPI 1588644819

  TN

  Medicare reassignment

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

{
    "created_epoch": "1770768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770768000000",
    "number": "1689526741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1821 N WASHINGTON ST",
            "city": "TULLAHOMA",
            "state": "TN",
            "postal_code": "373882221",
            "telephone_number": "931-455-2005",
            "fax_number": "931-455-4450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1821 N WASHINGTON ST",
            "city": "TULLAHOMA",
            "state": "TN",
            "postal_code": "373882221",
            "telephone_number": "931-455-2005",
            "fax_number": "931-455-4450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED FACIAL AESTHETICS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-02-11",
        "last_updated": "2026-02-11",
        "certification_date": "2026-02-11",
        "status": "A",
        "authorized_official_last_name": "HICKERSON",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "CREDENTIALING FACILITATOR",
        "authorized_official_telephone_number": "931-461-5056"
    },
    "taxonomies": [
        {
            "code": "207YX0905X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dale Owen Hunter II, D.M.D.
• Micah Lane Hyman, M.S.
• Elizabeth Illenberg, FNP
• Independent Physical Therapy
• Alton Earl Ingram Jr., MD
• Integrity Healthcare Staffing
• Intelligent Quantified Fitness, LLC
• Internal Medicine Associates of Tullahoma PC (Internal Medicine Associates)
• Leslie Iorio
• J&K Services LLC

• Otolaryngology/Facial Plastic Surgery Physician in Tullahoma, TN
• Providers in Tullahoma, TN by specialty
• Otolaryngology/Facial Plastic Surgery Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2026; 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.