Healthcare Provider Details

I. General information

NPI: 1821517285
Provider Name (Legal Business Name): PYGMY BLUE HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2017
Last Update Date: 07/13/2025
Certification Date: 07/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 IDLEWILD DR
MADISON TN
37115-4744
US

IV. Provider business mailing address

705 S BROADWAY ST # 1007
PORTLAND TN
37148-1628
US

V. Phone/Fax

Practice location:
  • Phone: 615-521-0191
  • Fax:
Mailing address:
  • Phone: 615-521-0191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. KAREN L GOLDEN
Title or Position: MEMBER
Credential: NP
Phone: 615-521-0191