Phillip Bradley Tatum, FNP
Individual provider Active NPI Nurse Practitioner · Linden, TN
NPI 1992736334 · NPPES record last updated Feb 26, 2020
Key facts
- NPI
- 1992736334
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- APN0000012073 (TN)
- Practice address
- 115 E Brooklyn St
Linden, TN 37096-3515 - Phone
- (931) 589-2104
- Fax
- (931) 589-2513
- NPI assigned
- Jul 5, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Owned or controlled facilities with NPI records 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
All facility ownership & control disclosures 3
| Facility | Type | Role | Since |
|---|---|---|---|
| Three Rivers Community Health Group |
Federally qualified health center | Corporate Officer Corporate Director W-2 Managing Employee |
Mar 26, 2015 Mar 26, 2015 Mar 6, 2015 |
| Three Rivers Community Health Group |
Federally qualified health center | Corporate Officer W-2 Managing Employee |
Jan 1, 2011 Jan 1, 2011 |
| Perry County Dental Clinic |
Federally qualified health center | Corporate Officer Corporate Director W-2 Managing Employee |
Sep 1, 2025 Sep 1, 2025 Sep 1, 2025 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070303000049 | TN | Practitioner - Nurse Practitioner | 0143322594 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| APN0000012073 | TN | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Perry County Medical Center, Inc. | Current |
Accepting new patients | |
| Perry County Medical Center Inc | Current |
Accepting new patients | |
| Perry County Medical Center, Inc. | Past | Accepting new patients |
Locations
115 E Brooklyn St
Linden, TN 37096
Phone (615) 589-2104
Interoperability endpoints
- phillip.tatum.p1@direct.trchg.nextgenshare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | APN0000012073 | TN | Yes |
Addresses
Primary practice location
115 E Brooklyn St
Linden, TN 37096-3515
Mailing address
PO Box 916
Linden, TN 37096-0916
Phone (931) 589-2104
Other providers in Linden, TN
- Patricia W Smith
- Smiths Pharmacy
- State of Tennessee
- Stephen L. Averett
- Vivian Denise Stokes
- Christopher Brent Taylor
- Treatment Recovery Associates LLC
- Lawanda Gaye Trull
- Unity Hospice Care of Tennessee, LLC
- Valerie Votaw
All providers in Linden, TN · Nurse Practitioner in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 26, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.