Waddell Clinic Primary Care & Aesthetics PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

WADDELL CLINIC PRIMARY CARE & AESTHETICS PLLC

Practice address

9785 Hwy 79 S
Henry, TN 38231

Phone

(731) 423-1450

Fax

(731) 423-1000

NPI assigned

Nov 3, 2023

Last updated

May 31, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Donna Waddell, NP-CNPI 1871733162

Title

Owner

Phone

(731) 415-8277

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Donna Jane Waddell, NP

  • Family Nurse Practitioner
  • Henry, TN
  • NPI 1871733162
  Medicare reassignment Care Compare group NPD Authorized official
• Janson David Davis, PA-C

  • Physician Assistant
  • Henry, TN
  • NPI 1326780487
  Medicare reassignment Care Compare group
• Markie Brooke Anderson

  • Family Nurse Practitioner
  • Henry, TN
  • NPI 1326997495
  Medicare reassignment NPD

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

{
    "created_epoch": "1698969600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717113600000",
    "number": "1851164560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9785 HIGHWAY 79 S",
            "city": "HENRY",
            "state": "TN",
            "postal_code": "382313613",
            "telephone_number": "731-243-1450",
            "fax_number": "731-243-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9785 HWY 79 S",
            "city": "HENRY",
            "state": "TN",
            "postal_code": "38231",
            "telephone_number": "731-423-1450",
            "fax_number": "731-423-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WADDELL CLINIC PRIMARY CARE & AESTHETICS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-03",
        "last_updated": "2024-05-31",
        "certification_date": "2024-05-31",
        "status": "A",
        "authorized_official_last_name": "WADDELL",
        "authorized_official_first_name": "DONNA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "731-415-8277",
        "authorized_official_credential": "NP-C"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Markie Brooke Anderson
• Casey Crosser, ATC,CSCS
• Janson David Davis, PA-C
• Pamala Milton, COTA
• Donna Jane Waddell, NP

• Family Medicine Physician in Henry, TN
• Providers in Henry, 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 May 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.