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NPI Code Detail

MEDICARE: NITEOWL PEDIATRICS, LLC

MEDICARE: NITEOWL PEDIATRICS, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1871887430
Entity Type Code : Organization
Provider Name (Legal Business Name) : NITEOWL PEDIATRICS, LLC
Provider Business Mailing Address
First Line : 9219 LEE HWY STE 103
Second Line :
City : OOLTEWAH
State : TN
Zip : 37363-4440
Country : US
Telephone Number : 423-648-6483
Fax Number : 423-648-6497
Provider Business Practice Location Address
First Line : 9219 LEE HWY STE 103
Second Line :
City : OOLTEWAH
State : TN
Zip : 37363-4440
Country : US
Telephone Number : 423-648-6483
Fax Number : 423-648-6497
Authorized Official
Title or Position : DIRECTOR OF OPERATIONS
Name : AMANDA PRITCHETT
Credential :
Telephone Number : 423-648-6483
Provider Enumeration Date : 06/01/2011
Last Update Date : 06/02/2026

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Directions to “NITEOWL PEDIATRICS, LLC ” Practice Location

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