Individual provider Active NPI

Brianna Megan Dale, NP

  • Pediatric Nurse Practitioner
  • Memphis, TN
National Provider Identifier
1780169441
Registry record updated Sep 28, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
PENDING Issued in TN
Practice address
848 Adams Ave.
Ste. L400
Memphis, TN 38103
Phone
(901) 287-7337
Fax
(901) 287-4540
NPI assigned
Sep 28, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X PENDING TN Primary

Addresses

Primary practice location

848 Adams Ave.
Ste. L400
Memphis, TN 38103

Mailing address

850 Poplar Ave.
BLDG. 2
Memphis, TN 38105

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
I20190520002752 TN Practitioner - Nurse Practitioner 3779826425 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ut Lebonheur Pediatric Specialists, Inc.Group PAC ID 7719173939, 162 clinicians

Practice addresses (Care Compare)

100 N Humphreys Blvd
Memphis, TN 38120-2146
Phone (901) 287-7337

848 Adams Ave
Memphis, TN 38103-2816

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PENDINGTNMDOccupational Therapy Assistant

Interoperability endpoints

  • Direct secure messaging: bdale23263@mlh.direct-ci.com

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1538092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538092800000",
    "number": "1780169441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 POPLAR AVE.",
            "address_2": "BLDG. 2",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "38105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "848 ADAMS AVE.",
            "address_2": "STE. L400",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "38103",
            "telephone_number": "901-287-7337",
            "fax_number": "901-287-4540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DALE",
        "first_name": "BRIANNA",
        "middle_name": "MEGAN",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-28",
        "last_updated": "2018-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "TN",
            "license": "PENDING",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

Verify at the official NPI Registry.