Heather Stafford
Individual provider Active NPI Nurse Practitioner · Gainesboro, TN
NPI 1891551784 · NPPES record last updated Feb 27, 2024
Key facts
- NPI
- 1891551784
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 35808 (TN)
- Practice address
- 1340 N Grundy Quarles Hwy
Gainesboro, TN 38562-6001 - Phone
- (931) 268-0291
- NPI assigned
- Feb 27, 2024
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Ultra Health LLC
Practice addresses (Care Compare)
4128 Old Jackson Rd
Bells, TN 38006-4261
Phone (731) 394-1145
Hospital & facility affiliations
- Macon Community Hospital
- Livingston Regional Hospital
- Mabry Health Care
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240308002223 | TN | Practitioner - Nurse Practitioner | 1557707858 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ultra Health LLC | Nurse Practitioner | Current |
Accepting new patients |
| Ultra Health Providers III LLC | Current |
Accepting new patients |
Locations
490 W Poplar Ave
Collierville, TN 38017
Phone (901) 844-1439
1340 N Grundy Quarles Hwy
Gainesboro, TN 38562
Phone (423) 442-3990
405 Times Ave
Lafayette, TN 37083
Phone (615) 666-3170
309 Main St
Red Boiling Springs, TN 37150
Phone (270) 487-9272
Interoperability endpoints
- https://api.platform.athenahealth.com/14578/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 35808 | TN | Yes |
Addresses
Primary practice location
1340 N Grundy Quarles Hwy
Gainesboro, TN 38562-6001
Mailing address
972 Haydenburg Rd
Whitleyville, TN 38588-7059
Other practice location 1
405 Times Ave
Lafayette, TN 37083-1247
Phone (615) 666-3170
Other providers in Gainesboro, TN
- Kristi Malena Lafever
- Kendra Diann Maynard
- Alexa Allison Miller
- Courtney Roberts
- Kursten McKenzie Roop
- Kelsie Stafford
- Margie A Stafford
- State of Tennessee
- Erin Kate Stooksbury
- The Grove Family Wellness LLC
All providers in Gainesboro, TN · Nurse Practitioner in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 27, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.