Lakeside Medical, PLLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

16734 Issued in TN

Legal business name

LAKESIDE MEDICAL, PLLC

Practice address

127 W Meeting St
Dandridge, TN 37725-4747

Phone

(865) 397-6680

Fax

(865) 397-6681

NPI assigned

Aug 26, 2014

Organization subpart

No

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

Authorized official

Name

Kristin Belcher, MSN, FNP-BCNPI 1861742322

Title

Owner/FNP

Phone

(865) 397-6680

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

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

• Kristin Leann Belcher, FNP-BC

  • Family Nurse Practitioner
  • Dandridge, TN
  • NPI 1861742322
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1409011200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661299200000",
    "number": "1962802009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "127 W MEETING ST",
            "city": "DANDRIDGE",
            "state": "TN",
            "postal_code": "377254747",
            "telephone_number": "865-397-6680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "127 W MEETING ST",
            "city": "DANDRIDGE",
            "state": "TN",
            "postal_code": "377254747",
            "telephone_number": "865-397-6680",
            "fax_number": "865-397-6681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE MEDICAL, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-26",
        "last_updated": "2022-08-24",
        "certification_date": "2022-08-24",
        "status": "A",
        "authorized_official_last_name": "BELCHER",
        "authorized_official_first_name": "KRISTIN",
        "authorized_official_title_or_position": "OWNER/FNP",
        "authorized_official_telephone_number": "865-397-6680",
        "authorized_official_credential": "MSN, FNP-BC"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "16734",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Nurse Practitioner in Dandridge, TN
• Providers in Dandridge, TN by specialty
• Family Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.