Provider Demographics
NPI:1285212498
Name:KIDS FIRST PEDIATRICS, PC
Entity Type:Organization
Organization Name:KIDS FIRST PEDIATRICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:SEAWELL-WYNN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-819-5431
Mailing Address - Street 1:6312 HIGHWAY 41A STE 102
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VIEW
Mailing Address - State:TN
Mailing Address - Zip Code:37146-8221
Mailing Address - Country:US
Mailing Address - Phone:615-819-5431
Mailing Address - Fax:
Practice Address - Street 1:6312 HIGHWAY 41A STE 102
Practice Address - Street 2:
Practice Address - City:PLEASANT VIEW
Practice Address - State:TN
Practice Address - Zip Code:37146-8221
Practice Address - Country:US
Practice Address - Phone:615-819-5431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-30
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3333798Medicaid