Courtney Paige Pendergraft, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

0024169574 Issued in VA

Practice address

130 W Ravine Rd
Kingsport, TN 37660-3837

Phone

(423) 224-4000

Fax

(423) 224-5120

NPI assigned

Aug 12, 2011

Last updated

Aug 12, 2011By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in TN, VA, KY3 enrollments

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 3

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Guardian Biologics LLC

  • Specialist
  • Mount Juliet, TN
  • NPI 1033890876

  KY

  Medicare reassignment NPD
• Regional Healthcare Group LLC

  • Acute Care Nurse Practitioner
  • Mount Juliet, TN
  • NPI 1407587363

  KY, VA

  Medicare reassignment NPD
• Tri-Cities Observation Services, PC

  • Emergency Medicine Physician
  • Johnson City, TN
  • NPI 1154860146
  Medicare reassignment NPD
• Tri-Cities Regional Emergency Physicians, PC

  • Emergency Medicine Physician
  • Johnson City, TN
  • NPI 1063950046
  Medicare reassignment NPD
• Old Mission Wound Care Tennessee PLLC

  • Specialist
  • Traverse City, MI
  • NPI 1912746389

  TN

  Medicare reassignment NPD
• Old Mission Wound Care Virginia PLLC

  • Specialist
  • Traverse City, MI
  • NPI 1255170627

  VA

  Medicare reassignment NPD
• University of Virginia Physicians Group

  • Sports Medicine (Neuromusculoskeletal Medicine) Physician
  • Charlottesville, VA
  • NPI 1033138250
  Medicare reassignment
• Western Virginia Regional Emergency Physicians, LLC

  • Emergency Medicine Physician
  • Norton, VA
  • NPI 1386183028
  Medicare reassignment
• Rebirth Advanced Healing LLC

  • Specialist
  • Johnson City, TN
  • NPI 1174390413
  NPD

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

{
    "created_epoch": "1313107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1313107200000",
    "number": "1790064384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11724",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379391724",
            "telephone_number": "865-766-8800",
            "fax_number": "865-766-8874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 W RAVINE RD",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376603837",
            "telephone_number": "423-224-4000",
            "fax_number": "423-224-5120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENDERGRAFT",
        "first_name": "COURTNEY",
        "middle_name": "PAIGE",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-08-12",
        "last_updated": "2011-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024169574",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charles E Payne, MD
• Ethan Pearcy, PT
• Caleb Pearson, DPT
• Pedirite Medical TN PLLC
• Deborah Fry Pencarinha, M.S.
• Anna Pendleton, FNP
• Christopher A Pendola, M.D.
• Skylar Dane Pentasuglia, AUD
• Katie E Perdue
• Kiley Morgan Perethian, D.O.

• Family Nurse Practitioner in Kingsport, TN
• Providers in Kingsport, TN by specialty
• Family Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2011; 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.