Individual provider Active NPI

Nyeesha Renelle Waters, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Knoxville, TN
National Provider Identifier
1902557770
Registry record updated Jan 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
30876 Issued in TN
Practice address
265 Brookview Centre Way Ste 400
Knoxville, TN 37919-4052
Phone
(800) 342-2898
NPI assigned
Jan 13, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 13, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LP0808X 30876 TN Primary

Addresses

Primary practice location

265 Brookview Centre Way Ste 400
Knoxville, TN 37919-4052

Mailing address

1408 Station Four LN
Old Hickory, TN 37138-2353
Phone (502) 224-5553

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220208001706 TN Practitioner - Nurse Practitioner 4789077116 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Centerstone of Tennessee, Inc.Group PAC ID 9739088113, 114 clinicians

Practice addresses (Care Compare)

332 Sumner Hall Dr
Gallatin, TN 37066-3129
Phone (888) 291-4357

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
30876TNMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Centerstone of Tennessee, Inc. Single Specialty CurrentSince Jan 23, 2023 Accepting new patients
Centerstone of Tennessee, Inc. Single Specialty CurrentSince Jan 23, 2023 Accepting new patients

Locations

332 Sumner Hall Dr
Gallatin, TN 37066
Phone (615) 451-5190

1921 Ransom Pl
Nashville, TN 37217
Phone (615) 279-6700

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1642032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642032000000",
    "number": "1902557770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1408 STATION FOUR LN",
            "city": "OLD HICKORY",
            "state": "TN",
            "postal_code": "371382353",
            "telephone_number": "502-224-5553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "265 BROOKVIEW CENTRE WAY STE 400",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379194052",
            "telephone_number": "800-342-2898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATERS",
        "first_name": "NYEESHA",
        "middle_name": "RENELLE",
        "name_prefix": "Mrs.",
        "credential": "PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-01-13",
        "last_updated": "2022-01-13",
        "certification_date": "2022-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TN",
            "license": "30876",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Knoxville, TN

Sources for this page

Verify at the official NPI Registry.