The Pediatric Clinic PLLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

THE PEDIATRIC CLINIC PLLC

Practice address

11870 Cranston Dr Ste 104
Arlington, TN 38002-4913

Phone

(901) 831-8190

NPI assigned

Apr 1, 2021

Organization subpart

No

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

Authorized official

Name

Lisa PowellNPI 1619431780

Title

Owner

Phone

(901) 317-7958

Specialties & licenses 1

Addresses

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lisa Dawn Powell, FNP-BC

  • Family Nurse Practitioner
  • Arlington, TN
  • NPI 1619431780

  Single Specialty

  NPD Authorized official
• Heather Dawn Vandiver, MSN, FNP-C

  • Nurse Practitioner
  • Arlington, TN
  • NPI 1316634140
  NPD
• Malinda Manzo, APN

  • Pediatric Nurse Practitioner
  • Eads, TN
  • NPI 1962663849
  NPD (past)

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

{
    "created_epoch": "1617235200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620432000000",
    "number": "1962080614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11870 CRANSTON DR STE 104",
            "city": "ARLINGTON",
            "state": "TN",
            "postal_code": "380024913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11870 CRANSTON DR STE 104",
            "city": "ARLINGTON",
            "state": "TN",
            "postal_code": "380024913",
            "telephone_number": "901-831-8190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE PEDIATRIC CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-01",
        "last_updated": "2021-05-08",
        "certification_date": "2021-05-08",
        "status": "A",
        "authorized_official_last_name": "POWELL",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "901-317-7958"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heather H Taylor, NP
• Tennessee CVS Pharmacy, L.L.C.
• Tennessee Dental Professionals, PC
• Tennessee State Veterans Home Board-Arlington
• The Nurse Connect, LLC
• Cathy Tilley Thompson, CMSW
• Margaret Mary Schiffer Thomson
• Melissa Thurmer
• James B Townsend
• Britney Myly Madrid Tran, PHARMD

• Pediatrics Physician in Arlington, TN
• Providers in Arlington, TN by specialty
• Pediatrics Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.