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FAITH FAMILY WALK IN CLINIC LLC
NPI 1508662354
General Practice in Dyersburg, TN

Active since February 21, 2025CLIA 44D2320811 · Waiver
2095 SAINT JOHN AVE, DYERSBURG, TN 38024(731) 445-5039 Get Directions Write a Review

NPPES record last updated: July 8, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jul 8, 2025, Feb 21, 2025 (2 updates tracked since 2025).

About Faith Family Walk In Clinic Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

FAITH FAMILY WALK IN CLINIC LLC (NPI 1508662354) is a healthcare organization registered as a general practice in Dyersburg, Tennessee and active in the NPI registry since February 2025. The organization holds a CLIA Waiver certificate valid through March 24, 2027 and lists Angela Upchurch, Family Nurse Practitioner, as its authorized official.

NPPES Registry Identity

NPI1508662354
Entity TypeOrganization
Primary Taxonomy208D00000X
Legal Business NameFAITH FAMILY WALK IN CLINIC LLC
Location Address2095 SAINT JOHN AVEDyersburg, TN 38024-2209
Mailing Address2095 Saint John AveDyersburg, TN 38024-2209 · (731) 334-5353 · Fax (731) 334-5418
Phone(731) 445-5039
Organization SubpartNo
Authorized OfficialAngela UpchurchFamily Nurse Practitioner · (731) 334-5353
Enumeration DateFebruary 21, 2025
Last NPPES UpdateJuly 8, 20252 updates tracked since enumeration
NPPES CertifiedJuly 8, 2025
✔ NPI 1508662354 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians
Taxonomy Code208D00000X
Definition
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee
2095 SAINT JOHN AVE, Dyersburg, TN 38024
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Faith Family Walk In Clinic Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

3

Medicare enrollment records show 3 clinicians reassign Medicare billing to Faith Family Walk In Clinic LLC, which bills Medicare for the services they deliver. Of these, 2 practice at this address and 3 within 10 miles. They are listed nearest first.

Clinicians, nearest first (3)

Bradley Gatlin
Nurse Practitioner
NPI 1225757008
2095 SAINT JOHN AVE
Dyersburg, TN 38024
(731) 334-5353
✔ PECOS✔ Accepts MedicareSame address
Angela Upchurch, NP-C
Nurse Practitioner
NPI 1275033888
2095 SAINT JOHN AVE
Dyersburg, TN 38024
(731) 334-5353
✔ PECOS✔ Accepts MedicareSame address
Amber Sullivan, FNP-BC
Nurse Practitioner
NPI 1467158105
400 E TICKLE ST
Dyersburg, TN 38024
(731) 287-2308
✔ PECOS✔ Accepts Medicare1.6 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 44D2320811

Faith Family Walk In Clinic LLC · Dyersburg, TN
Active · expires Mar 24, 2027
CLIA Number44D2320811
Laboratory TypePractitioner Other
Certificate Effective DateMarch 25, 2025
Certificate Expiration DateMarch 24, 2027
Laboratory DirectorAngela Upchurch
Laboratory Phone(731) 445-9726
Laboratory LocationFaith Family Walk In Clinic LLC2095 Saint John Ave, Dyersburg, TN 38024
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Faith Family Walk In Clinic LLC's NPI number?

The NPI number for Faith Family Walk In Clinic LLC is 1508662354. It was assigned to this organization in the NPPES registry on February 21, 2025.

Where is Faith Family Walk In Clinic LLC located?

Faith Family Walk In Clinic LLC is located at 2095 Saint John Ave, Dyersburg, TN 38024. The listed phone number is (731) 445-5039.

What is Faith Family Walk In Clinic LLC's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

Is Faith Family Walk In Clinic LLC enrolled in Medicare?

Yes. Faith Family Walk In Clinic LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Faith Family Walk In Clinic LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians, all in Nurse Practitioner, reassign their Medicare billing to Faith Family Walk In Clinic LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 2 practice at this address and 3 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Faith Family Walk In Clinic LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 44D2320811) is associated with this NPI, valid through March 24, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Faith Family Walk In Clinic LLC was last updated on July 8, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.