The Fatigue Clinic LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

12687 Issued in TN

Legal business name

THE FATIGUE CLINIC LLC

Practice address

890 W Poplar Ave Ste 6
Collierville, TN 38017-2582

Phone

(901) 221-8621

Fax

(901) 221-8631

NPI assigned

Nov 22, 2011

Organization subpart

No

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

Authorized official

Name

Susan D Earl, ACNPNPI 1093931719

Title

Owner/Provider

Phone

(901) 221-8621

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Locations

Practitioners 1

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

• Susan D Earl, NP

  • Acute Care Nurse Practitioner
  • Collierville, TN
  • NPI 1093931719

  TN

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1321920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597276800000",
    "number": "1962779645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "890 W POPLAR AVE STE 6",
            "city": "COLLIERVILLE",
            "state": "TN",
            "postal_code": "380172582",
            "telephone_number": "901-221-8621",
            "fax_number": "901-221-8631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "890 W POPLAR AVE STE 6",
            "city": "COLLIERVILLE",
            "state": "TN",
            "postal_code": "380172582",
            "telephone_number": "901-221-8621",
            "fax_number": "901-221-8631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE FATIGUE CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-22",
        "last_updated": "2020-08-13",
        "certification_date": "2020-08-13",
        "status": "A",
        "authorized_official_last_name": "EARL",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "901-221-8621",
        "authorized_official_credential": "ACNP"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "TN",
            "license": "12687",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Collierville, TN
• Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.