PEDIATRIC ASSOCIATES OF WEST TENNESSEE PLLC; NPI #1679929285

Contact Information

PEDIATRIC ASSOCIATES OF WEST TENNESSEE PLLC

1501 BRAYTON AVE
DYERSBURG, TN 38024-3158

Phone: 731-285-4111
Fax:
Website:

Specialty	Taxonomy Code	Specialty Code	Provider Type
Rural Health	261QR1300X	B4[14]	Rural Health Clinic
Pediatrics	363LP0200X	50	Nurse Practitioner

Indicates primary specialty

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NPI Profile & details for PEDIATRIC ASSOCIATES OF WEST TENNESSEE PLLC

NPI # 1679929285

LBN Legal business name PEDIATRIC ASSOCIATES OF WEST TENNESSEE PLLC

Authorized official JAMIE ELLERBROOK - (OWNER)

Entity Organization

Organization subpart ¹ No

Enumeration date 05/12/2016

Last updated 05/14/2025 - More than a year ago

Identifiers

License #

0000014756

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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