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

Ursula Treadaway, PA-C

Individual provider Medical Physician Assistant · NPI 1104364918

Ursula Treadaway, PA-C is a Physician Assistant in Kodak, Tennessee. Graduated from Lincoln Memorial University Medical Department in 2011, 15 years ago. Accepts Medicare assignment.

Years since qualifying
15
Trained at
Lincoln Memorial University Medical Department
In the registry since
2017
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

See every abbreviation used in this directory →

Practice location Address checks out

3609 Outdoor Sportsman Pl Ste 7
Kodak, TN 37764-1477
Phone: (652) 815-9228
Fax: (865) 766-5396
Show map & directions

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

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X
Medical Physician Assistant Taxonomy 363AM0700X

Record details

NPI number1104364918
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedFebruary 1, 2017
Last updated in NPPESDecember 11, 2019
Certification dateDecember 11, 2019

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolLINCOLN MEMORIAL UNIVERSITY MEDICAL DEPARTMENT
Graduated 2011 (15 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount