Kristen Marie Wolfenbarger, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

DO0000002801 Issued in TN

Practice address

423 Medical Park Dr Ste 100
Lenoir City, TN 37772-5641

Phone

(865) 270-6600

Fax

(865) 374-2102

NPI assigned

May 3, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Kristen Marie Broadhead Former name

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• Covenant Medical Group, Inc.

  • Family Medicine Physician
  • Knoxville, TN
  • NPI 1457302010
  Medicare reassignment NPD
• Covenant Medical Group, Inc

  • Durable Medical Equipment & Medical Supplies
  • Knoxville, TN
  • NPI 1871269415
  NPD

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

{
    "created_epoch": "1272844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619654400000",
    "number": "1780901595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "423 MEDICAL PARK DR STE 100",
            "city": "LENOIR CITY",
            "state": "TN",
            "postal_code": "377725641",
            "telephone_number": "865-270-6600",
            "fax_number": "865-374-2102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "423 MEDICAL PARK DR STE 100",
            "city": "LENOIR CITY",
            "state": "TN",
            "postal_code": "377725641",
            "telephone_number": "865-270-6600",
            "fax_number": "865-374-2102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLFENBARGER",
        "first_name": "KRISTEN",
        "middle_name": "MARIE",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-05-03",
        "last_updated": "2021-04-29",
        "certification_date": "2021-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "DO0000002801",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1534541",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTEN",
            "last_name": "BROADHEAD",
            "middle_name": "MARIE",
            "credential": "D.O.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jenna Whipple, CCC-SLP
• Timothy Wilburn, CPHT
• Diana Elizabeth Williams, PHARMD
• Megan Wilson, PA
• Alexis Grace Woelk
• Emma Womack
• Gracie Wood, RN
• Jim Brian Young, APN
• Nancy Young, PT
• Kenneth Zalewski, MSN- CRNA

• Family Medicine Physician in Lenoir City, TN
• Providers in Lenoir City, TN by specialty
• Family Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.