NPIMap

Organization Active NPI

NP Enterprises, Inc.

Doing business as Family Walk In Clinic

  • Family Nurse Practitioner
  • Crossville, TN
National Provider Identifier
1932139946
Registry record updated Dec 16, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
0342120-22 Issued in TN
Legal business name
NP ENTERPRISES, INC.
Doing business as
Family Walk In Clinic
Practice address
42 Dooley St
Crossville, TN 38555-4055
Phone
(931) 707-7117
Fax
(931) 707-7113
NPI assigned
Jul 4, 2006
Last updated
Dec 16, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2009

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

Authorized official

Name
Jerry Pernell, C.F.N.P.NPI 1548460447
Title
President
Phone
(931) 707-7117

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 0342120-22 TN Primary

Addresses

Primary practice location

42 Dooley St
Crossville, TN 38555-4055

Mailing address

42 Dooley St
Crossville, TN 38555-4055
Phone (931) 707-7117

Other identifiers 3

IdentifierTypeStateIssuer
4087535OtherTNTENNCARE SELECT SERV PROV
4087536OtherTNBLUE CROSS BLUE SHIELD
3726617MedicaidTN

Other names 1

  • Family Walk In Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041019000825 TN Part B Supplier - Clinic/Group Practice 9638130164 Receives reassigned benefits from 4 practitioners
Practice locations: Crossville, TN
O20110706000295 TN Part A Provider - Rural Health Clinic 9638130164 Practice locations: Crossville, TN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1932139946. Details of each certification follow.

Rural health clinic certification: CCN 448909

Legal name
NP ENTERPRISES, INC.
Doing business as
FAMILY WALK-IN CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 24, 2011
Last certification
Jul 31, 2017
Ownership / control type
1B
Organization structure
CorporationProprietary
Incorporated
Jul 10, 2003 in TN
Enrollment address
42 Dooley Street
Crossville, TN 38555-4055

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Joshua Stephen White Individual W-2 Managing EmployeePhysician Assistant Apr 6, 2026
Jerry W Pernell Individual 5% Or Greater Direct Ownership Interest Apr 1, 2011 100%
Corporate Officer Apr 1, 2011 100%
Corporate Director Apr 1, 2011 100%
W-2 Managing Employee Apr 1, 2011 100%

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1260921600000",
    "number": "1932139946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "42 DOOLEY ST",
            "city": "CROSSVILLE",
            "state": "TN",
            "postal_code": "385554055",
            "telephone_number": "931-707-7117",
            "fax_number": "931-707-7113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "42 DOOLEY ST",
            "city": "CROSSVILLE",
            "state": "TN",
            "postal_code": "385554055",
            "telephone_number": "931-707-7117",
            "fax_number": "931-707-7113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NP ENTERPRISES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-04",
        "last_updated": "2009-12-16",
        "status": "A",
        "authorized_official_last_name": "PERNELL",
        "authorized_official_first_name": "JERRY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "931-707-7117",
        "authorized_official_credential": "C.F.N.P."
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "0342120-22",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TENNCARE SELECT SERV PROV",
            "identifier": "4087535",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "4087536",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3726617",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Walk In Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Crossville, TN

Sources for this page

Verify at the official NPI Registry.