Tncoviddefense

Primary specialty

Nursing Care AgencyTaxonomy code 251J00000X

Legal business name

TNCOVIDDEFENSE

Practice address

33 Reynolds St
MC Kenzie, TN 38201-2051

Phone

(731) 358-4062

NPI assigned

Aug 4, 2021

Organization subpart

No

Name

Michael Fuller, LPNNPI 1013577667

Title

Owner

Phone

(731) 358-4062

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael Fuller, LPN

  • Licensed Practical Nurse
  • Mayfield, KY
  • NPI 1013577667
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 4, 2021.

{
    "created_epoch": "1628035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628035200000",
    "number": "1801560768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33 REYNOLDS ST",
            "city": "MC KENZIE",
            "state": "TN",
            "postal_code": "382012051",
            "telephone_number": "731-358-4062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33 REYNOLDS ST",
            "city": "MC KENZIE",
            "state": "TN",
            "postal_code": "382012051",
            "telephone_number": "731-358-4062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TNCOVIDDEFENSE",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-04",
        "last_updated": "2021-08-04",
        "certification_date": "2021-08-04",
        "status": "A",
        "authorized_official_last_name": "FULLER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "731-358-4062",
        "authorized_official_credential": "LPN"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP0905X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Public Health, State or Local",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.TNCovidDefense.org",
            "affiliation": "N",
            "endpointDescription": "main website",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "33 Reynolds St",
            "city": "Mc Kenzie",
            "state": "TN",
            "country_code": "US",
            "postal_code": "382012051",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.TNCovidDefense.org",
            "affiliation": "N",
            "endpointDescription": "main website",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "33 Reynolds St",
            "city": "Mc Kenzie",
            "state": "TN",
            "country_code": "US",
            "postal_code": "382012051",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2021; 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.