Waverly Pediatric and Adult Care

Primary specialty

Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X

License

MD8719 Issued in TN

Legal business name

WAVERLY PEDIATRIC AND ADULT CARE

Practice address

1034 W Main St
Waverly, TN 37185-1447

Phone

(931) 296-7000

Fax

(931) 296-7231

NPI assigned

Jun 8, 2011

Last updated

Jun 8, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Mary Angela Skelton, M.D.

Title

Owner

Phone

(931) 296-7000

Specialties & licenses 2

Addresses

Locations

Practitioners 2

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.

• Mandi Nicole Beuerlein, APRN, FNP-BC

  • Family Nurse Practitioner
  • Waverly, TN
  • NPI 1982993796
  NPD (past)
• Melanie Leigh Dowling, CPNP

  • Pediatric Nurse Practitioner
  • Waverly, TN
  • NPI 1821317546
  NPD (past)

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

{
    "created_epoch": "1307491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1307491200000",
    "number": "1962796888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1034 W MAIN ST",
            "city": "WAVERLY",
            "state": "TN",
            "postal_code": "371851447",
            "telephone_number": "931-296-7000",
            "fax_number": "931-296-7231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1034 W MAIN ST",
            "city": "WAVERLY",
            "state": "TN",
            "postal_code": "371851447",
            "telephone_number": "931-296-7000",
            "fax_number": "931-296-7231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAVERLY PEDIATRIC AND ADULT CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-08",
        "last_updated": "2011-06-08",
        "status": "A",
        "authorized_official_last_name": "SKELTON",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "ANGELA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "931-296-7000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "364SF0001X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Family Health",
            "state": "TN",
            "license": "APN0000015777",
            "primary": false
        },
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "TN",
            "license": "MD8719",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wal-Mart Stores East LP (Walmart Pharmacy 10-0390)
• Jessica Nicole Waldrop, B.S.
• Susan Warren, PT
• Waverly Clinic PC
• Waverly Health Care and Rehabilitation Center, LLC
• Waverly SNF Healthcare LLC (Waverly Hills Post Acute)
• Wayland Alva Brooks
• Angelique Marie Wilcox, OTR/L, OTD
• Anneliese Wilsdorf, PA-C
• Ambra Lynn Wilson, PHARM. D.

• Pediatric Adolescent Medicine Physician in Waverly, TN
• Providers in Waverly, TN by specialty
• Pediatric Adolescent Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2011; 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.