Provider Demographics
NPI:1932139946
Name:NP ENTERPRISES, INC.
Entity Type:Organization
Organization Name:NP ENTERPRISES, INC.
Other - Org Name:FAMILY WALK IN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:PERNELL
Authorized Official - Suffix:
Authorized Official - Credentials:CFNP
Authorized Official - Phone:931-707-7117
Mailing Address - Street 1:42 DOOLEY ST
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-4055
Mailing Address - Country:US
Mailing Address - Phone:931-707-7117
Mailing Address - Fax:931-707-7113
Practice Address - Street 1:42 DOOLEY ST
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-4055
Practice Address - Country:US
Practice Address - Phone:931-707-7117
Practice Address - Fax:931-707-7113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0342120-22363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4087535OtherTENNCARE SELECT SERV PROV
TN4087536OtherBLUE CROSS BLUE SHIELD
TN3726617Medicaid
TN4087535OtherTENNCARE SELECT SERV PROV
TN4087536OtherBLUE CROSS BLUE SHIELD