Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Providence Pediatrics, LLC

Organization Nurse Practitioner · NPI 1821497942

Providence Pediatrics, LLC is a Nurse Practitioner in Gray, Tennessee. Licensed in Tennessee. Registered with an NPI since 2014.

Licensed in
TN
In the registry since
2014
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

140 Old Gray Station Rd Ste 200
Gray, TN 37615-3612
Phone: (423) 477-2042
Fax: (423) 477-4571
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence 6966 (TN)

Record details

NPI number1821497942
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Susan Pennypacker — Owner · (423) 477-2042
NPI enumeratedAugust 14, 2014
Last updated in NPPESAugust 14, 2014
Mailing address140 Old Gray Station Road, Suite 200, Gray, TN 37615-3612

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