MEDICARE: ASCEND 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
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1588441620
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASCEND PEDIATRICS, LLC

Provider Business Mailing Address
First Line	:	170 SOUTHERN WOODS CT
Second Line	:
City	:	COOKEVILLE
State	:	TN
Zip	:	38506-7864
Country	:	US
Telephone Number	:	931-349-8069
Fax Number	:

Provider Business Practice Location Address
First Line	:	108 4TH AVE S
Second Line	:
City	:	BAXTER
State	:	TN
Zip	:	38544-5145
Country	:	US
Telephone Number	:	931-349-8069
Fax Number	:

Authorized Official
Title or Position	:	PEDIATRIC NURSE PRACTITIONER
Name	:	DR. KASSIE BARNES
Credential	:	DNP, CPNP
Telephone Number	:	931-349-8069

Provider Enumeration Date	:	09/12/2023
Last Update Date	:	09/12/2023

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