PROVIDENCE PEDIATRICS, LLC
NPI 1821497942
Nurse Practitioner in Gray, TN

Q: What is Providence Pediatrics, LLC's NPI number?

The NPI number for Providence Pediatrics, LLC is 1821497942. It was assigned to this organization in the NPPES registry on August 14, 2014.

Q: What is Providence Pediatrics, LLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Active since August 14, 2014

140 OLD GRAY STATION ROAD, SUITE 200, GRAY, TN 37615(423) 477-2042(423) 477-4571 Get Directions Write a Review

NPPES record last updated: August 14, 2014. Verified against the NPPES registry weekly; last sync: October 25, 2026.

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About Providence Pediatrics, Llc NPPES

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

PROVIDENCE PEDIATRICS, LLC (NPI 1821497942) is a healthcare organization registered as a nurse practitioner in Gray, Tennessee and active in the NPI registry since August 2014. The organization lists Susan Kay Pennypacker, Owner, as its authorized official.

NPPES Registry Identity

NPI1821497942

Entity TypeOrganization

Primary Taxonomy363L00000X

Legal Business NamePROVIDENCE PEDIATRICS, LLC

Location Address140 OLD GRAY STATION ROAD, SUITE 200Gray, TN 37615-3612

Mailing Address140 Old Gray Station Road, Suite 200Gray, TN 37615-3612 · (423) 477-2042 · Fax (423) 477-4571

Phone(423) 477-2042

Fax(423) 477-4571

Organization SubpartNo

Authorized OfficialSusan Kay PennypackerOwner · (423) 477-2042

Enumeration DateAugust 14, 2014

✔ NPI 1821497942 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363L00000X

License✔ Licensed in TN · 6966

Definition

(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

140 OLD GRAY STATION ROAD, Gray, TN 37615

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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

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 Providence Pediatrics, LLC's NPI number?

The NPI number for Providence Pediatrics, LLC is 1821497942. It was assigned to this organization in the NPPES registry on August 14, 2014.

Where is Providence Pediatrics, LLC located?

Providence Pediatrics, LLC is located at 140 Old Gray Station Road Suite 200, Gray, TN 37615. The listed phone number is (423) 477-2042.

What is Providence Pediatrics, LLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

When was this NPI record last updated?

The NPPES record for Providence Pediatrics, LLC was last updated on August 14, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 years 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.