Active NPI
Vetres Oreather Statum, LPN
- Licensed Practical Nurse
- Fort Campbell, KY
National Provider Identifier
1902043300
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 0000068878
- Practice address
- 650 Joel Dr
Young Eagle Clinic
Fort Campbell, KY 42223-5318 - Phone
- (270) 798-8258
- Fax
- (270) 956-0444
- NPI assigned
- Jan 7, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 0000068878 | TN | Primary |
Addresses
Primary practice location
650 Joel Dr
Young Eagle Clinic
Fort Campbell, KY 42223-5318
Mailing address
650 Joel Dr
Young Eagle Clinic
Fort Campbell, KY 42223-5318
Phone (270) 798-8258
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0000068878 | Other | TN | NURSING LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0000068878 | TN | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1231286400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1231286400000",
"number": "1902043300",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "650 JOEL DR",
"address_2": "YOUNG EAGLE CLINIC",
"city": "FORT CAMPBELL",
"state": "KY",
"postal_code": "422235318",
"telephone_number": "270-798-8258",
"fax_number": "270-956-0444"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "650 JOEL DR",
"address_2": "YOUNG EAGLE CLINIC",
"city": "FORT CAMPBELL",
"state": "KY",
"postal_code": "422235318",
"telephone_number": "270-798-8258",
"fax_number": "270-956-0444"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STATUM",
"first_name": "VETRES",
"middle_name": "OREATHER",
"name_prefix": "Ms.",
"credential": "LPN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-01-07",
"last_updated": "2009-01-07",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "TN",
"license": "0000068878",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NURSING LICENSE",
"identifier": "0000068878",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Campbell, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.