Providence Pediatrics, LLC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

6966 Issued in TN

Legal business name

PROVIDENCE PEDIATRICS, LLC

Practice address

140 Old Gray Station Road
Suite 200
Gray, TN 37615-3612

Phone

(423) 477-2042

Fax

(423) 477-4571

NPI assigned

Aug 14, 2014

Organization subpart

No

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

Authorized official

Name

Ms. Susan Kay Pennypacker, FNP-CNPI 1194717157

Title

Owner

Phone

(423) 477-2042

Specialties & licenses 1

Addresses

Practitioners 1

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

• Susan Kay Pennypacker, FNP C

  • Family Nurse Practitioner
  • Gray, TN
  • NPI 1194717157
  NPD (past) Authorized official

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

{
    "created_epoch": "1407974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407974400000",
    "number": "1821497942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 OLD GRAY STATION ROAD",
            "address_2": "SUITE 200",
            "city": "GRAY",
            "state": "TN",
            "postal_code": "376153612",
            "telephone_number": "423-477-2042",
            "fax_number": "423-477-4571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 OLD GRAY STATION ROAD",
            "address_2": "SUITE 200",
            "city": "GRAY",
            "state": "TN",
            "postal_code": "376153612",
            "telephone_number": "423-477-2042",
            "fax_number": "423-477-4571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE PEDIATRICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-14",
        "last_updated": "2014-08-14",
        "status": "A",
        "authorized_official_last_name": "PENNYPACKER",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "KAY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "423-477-2042",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "FNP-C"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": "TN",
            "license": "6966",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mountain Wings; LLC
• Elizabeth Brezina Palmer, MD
• Susan Kay Pennypacker, FNP C
• Emily Dawn Peters, L.M.T.
• Premier Wound Care of Tennessee, PC
• William Machenzie Rasnick, PHARMD
• Joseph K Reid, P.A.
• Billie Reilly, PHARM.D.
• Renovus Medical Spa
• Connie Marion Reynolds, APRN BC

• Nurse Practitioner in Gray, TN
• Providers in Gray, TN by specialty
• Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2014; 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.