National Provider Identifier Database

PEDIATRIC ASSOCIATES OF WEST TENNESSEE PLLC
Rural Health


Contact Information

PEDIATRIC ASSOCIATES OF WEST TENNESSEE PLLC
1501 BRAYTON AVE
DYERSBURG, TN38024-3158
Phone: 731-285-4111
Fax:
Website:
Specialty Taxonomy Code
* Rural Health 261QR1300X
Pediatrics 363LP0200X

* Indicates primary specialty

NPI Profile & details for PEDIATRIC ASSOCIATES OF WEST TENNESSEE PLLC

NPI Number 1679929285
Legal business name
LBN
PEDIATRIC ASSOCIATES OF WEST TENNESSEE PLLC
Authorized official JAMIE ELLERBROOK - (OWNER)
Entity Organization
Organization subpart No
Enumeration date 05/12/2016
Last updated 05/14/2025 - More than a year ago
Sole proprietor1 Not specified
Identifiers
  • TN License #: 0000014756

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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