Judith L Dedeker, RN

Primary specialty

Emergency Registered NurseTaxonomy code 163WE0003X

License

71050 Issued in TN

Practice address

2650 Executive Park NW
Suite 5
Cleveland, TN 37312-2746

Phone

(423) 479-9679

Fax

(423) 559-9046

NPI assigned

Jul 11, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Registered Nurse

State licenses

Practice roles

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.

• Physician Services of Cleveland, PC

  • Emergency Medicine Physician
  • Cleveland, TN
  • NPI 1457378341
  NPD (past)

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

{
    "created_epoch": "1341964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1342656000000",
    "number": "1740545151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2650 EXECUTIVE PARK NW",
            "address_2": "SUITE 5",
            "city": "CLEVELAND",
            "state": "TN",
            "postal_code": "373122746",
            "telephone_number": "423-479-9679",
            "fax_number": "423-559-9046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2650 EXECUTIVE PARK NW",
            "address_2": "SUITE 5",
            "city": "CLEVELAND",
            "state": "TN",
            "postal_code": "373122746",
            "telephone_number": "423-479-9679",
            "fax_number": "423-559-9046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEDEKER",
        "first_name": "JUDITH",
        "middle_name": "L",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-11",
        "last_updated": "2012-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WE0003X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Emergency",
            "state": "TN",
            "license": "71050",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TN",
            "license": "16832",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tammy Lynn Davis, BCBA, LBA
• Lakita Dawston
• Dearmond and Jones DDS PC
• Eben A Dearmond Jr.
• Amanda Kelley Deaton
• Shannon Brittany Dedmon, FNP
• Christina Delgman
• Angel Shana Delk
• Minna Rena Deluca, NP
• Veronica Demaria, FNP-BC

• Emergency Registered Nurse in Cleveland, TN
• Providers in Cleveland, TN by specialty
• Emergency Registered Nurse in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.