| NPI Number | 1417696477 |
| Provider Name | Blaire Alexandria Berry-Young |
| Credential | |
| Specialization | |
| Medical School Name | |
| Graduation Year | |
| Gender | |
| Entity Type | Individual |
| PAC ID by PECOS | |
| Professional Enrollment ID | |
| Enumeration Date | 05/28/2022 |
| Last Update Date | 05/28/2022 |
| Business Practice address |
38 CHIPPEWA CIR, Jackson, 38305-1619 Tennessee View on Google Map |
| Business Practice phone | 731-277-6924 |
| Business Practice fax | |
| Mailing address |
PO BOX 10662, Jackson, 38308-0111 Tennessee View on Google Map |
| Other phone | 731-277-6924 |
| Other fax | |
| Email Address | shannonfig@domain.com Reval Email Address |
Practices in Jackson
Jackson, Tennessee
| Field Name | Field Value |
|---|---|
| NPI | 1417696477 |
| 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. | |
| Entity Type | Individual |
Code describing the type of health care provider that is being assigned an NPI. Codes are:
|
|
| Is Sole Proprietor | Y |
Indicate whether provider is a sole proprietor.
|
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| Provider Last Name (Legal Name) | Berry-Young |
| The last name of the provider (if an individual). If the provider is an individual, this is the legal name. This name must match the name on file with the Social Security Administration (SSA). In addition, the date of birth must match that on file with SSA. (First and last names are required for initial applications.) The First, Middle, Last and Credential(s) fields allow the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. | |
| Provider First Name | Blaire |
| The first name of the provider, if the provider is an individual. | |
| Provider Credential Text | LPN |
| The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS. | |
| Provider First Line Business Mailing Address | PO BOX 10662 |
| The first line mailing address of the provider being identified. This data element may contain the same information as ''Provider first line location address''. | |
| Provider Business Mailing Address City Name | Jackson |
| The City name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address City name''. | |
| Provider Business Mailing Address State Name | Tennessee |
| The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address State name''. | |
| Provider Business Mailing Address Postal Code | 38308-0111 |
| The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ''Provider location address postal code''. | |
| Provider Business Mailing Address Country Code | US |
| The country code in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address country code''. | |
| Provider Business Mailing Address Telephone Number | 731-277-6924 |
| The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ''Provider location address telephone number''. | |
| Provider First Line Business Practice Location Address | 38 CHIPPEWA CIR |
| The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. | |
| Provider Business Practice Location Address City Name | Jackson |
| The city name in the location address of the provider being identified. | |
| Provider Business Practice Location Address State Name | Tennessee |
| The State or Province name in the location address of the provider being identified. | |
| Provider Business Practice Location Address Postal Code | 38305-1619 |
| The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. | |
| Provider Business Practice Location Address Country Code | US |
| The country code in the location address of the provider being identified. | |
| Provider Business Practice Location Address Telephone Number | 731-277-6924 |
| The telephone number associated with the location address of the provider being identified. | |
| Provider Enumeration Date | 05/28/2022 |
| The date the provider was assigned a unique identifier (assigned an NPI). | |
| Last Update Date | 05/28/2022 |
| The date that a record was last updated or changed. | |
| Healthcare Provider Taxonomy Code #1 | 174200000X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 1 | A public or privately owned facility providing meals to individuals traveling long distances or receiving prolonged outpatient medical services away from home. |
| Healthcare Provider Taxonomy #1 | |
| Healthcare Provider Primary Taxonomy Switch 1 | N |
Primary Taxonomy:
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| Healthcare Provider Taxonomy Code #2 | 251V00000X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 2 | Definition to come... |
| Healthcare Provider Taxonomy #2 | |
| Healthcare Provider Primary Taxonomy Switch 2 | N |
Primary Taxonomy:
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| Healthcare Provider Taxonomy Code #3 | 172A00000X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 3 | A person employed to operate a motor vehicle as a carrier of persons or property. |
| Healthcare Provider Taxonomy #3 | |
| Healthcare Provider Primary Taxonomy Switch 3 | N |
Primary Taxonomy:
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| Healthcare Provider Taxonomy Code #4 | 332U00000X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 4 | Home-delivered meals are those services or activities designed to prepare and deliver one or more meals a day to an individual's residence in order to prevent institutionalization, malnutrition, and feelings of isolation. Component services or activities may include the cost of personnel, equipment, and food; assessment of nutritional and dietary needs; nutritional education and counseling; socialization services; and information and referral. |
| Healthcare Provider Taxonomy #4 | |
| Healthcare Provider Primary Taxonomy Switch 4 | N |
Primary Taxonomy:
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| Healthcare Provider Taxonomy Code #5 | 343900000X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 5 | A land vehicle with a capacity to meet special height, clearance, access, and seating, for the conveyance of persons in non-emergency situations. The vehicle may or may not be required to meet local county or state regulations. |
| Healthcare Provider Taxonomy #5 | |
| Healthcare Provider Primary Taxonomy Switch 5 | N |
Primary Taxonomy:
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| Healthcare Provider Taxonomy Code #6 | 347C00000X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 6 | An individual paid to provide non-emergency transportation using their privately owned/leased vehicle. |
| Healthcare Provider Taxonomy #6 | |
| Healthcare Provider Primary Taxonomy Switch 6 | N |
Primary Taxonomy:
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| Healthcare Provider Taxonomy Code #7 | 372500000X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 7 | An individual who provides home maintenance services required to sustain a safe, sanitary living environment for individuals who because of age or disabilities is unable to perform the activities. These services include heavy household chores such as washing floors, windows, and walls; tacking down loose rugs and tiles; and moving heavy items of furniture in order to provide safe access and egress. |
| Healthcare Provider Taxonomy #7 | |
| Healthcare Provider Primary Taxonomy Switch 7 | N |
Primary Taxonomy:
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| Healthcare Provider Taxonomy Code #8 | 372500000X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 8 | An individual who provides home maintenance services required to sustain a safe, sanitary living environment for individuals who because of age or disabilities is unable to perform the activities. These services include heavy household chores such as washing floors, windows, and walls; tacking down loose rugs and tiles; and moving heavy items of furniture in order to provide safe access and egress. |
| Healthcare Provider Taxonomy #8 | |
| Healthcare Provider Primary Taxonomy Switch 8 | N |
Primary Taxonomy:
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| Healthcare Provider Taxonomy Code #9 | 374700000X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 9 | (1) A person with specialized training in a narrow field of expertise whose occupation requires training and is skilled in specific technical processes and procedures. (2) An individual having special skill or practical knowledge in an area, such as operation and maintenance of equipment or performance of laboratory procedures involving biochemical analyses. Special technical qualifications are normally required, though an increasing number or technicians also possess university degrees in science, and occasionally doctorate degrees. The distinction between technician and technologist in the health care field is not always clear. |
| Healthcare Provider Taxonomy #9 | |
| Healthcare Provider Primary Taxonomy Switch 9 | N |
Primary Taxonomy:
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| Healthcare Provider Taxonomy Code #10 | 3747A0650X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 10 | An individual who provides hands-on care, of both a supportive and health related nature, specific to the needs of a medically stable, physically handicapped individual. Supportive services are those that substitute for the absence, loss, diminution, or impairment of a physical or cognitive function. This service may include skilled or nursing care to the extent permitted by state law. |
| Healthcare Provider Taxonomy #10 | |
| Healthcare Provider Primary Taxonomy Switch 10 | N |
Primary Taxonomy:
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| Healthcare Provider Taxonomy Code #11 | 3747P1801X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 11 | An individual who provides assistance with eating, bathing, dressing, personal hygiene, activities of daily living as specified in the plan of care. Services which are incidental to the care furnished, or essential to the health and welfare of the individual may also be provided. Personal care providers must meet state defined training and certification standards |
| Healthcare Provider Taxonomy #11 | |
| Healthcare Provider Primary Taxonomy Switch 11 | N |
Primary Taxonomy:
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| Healthcare Provider Taxonomy Code #12 | 376K00000X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 12 | (1) An unlicensed individual who is trained to function in an assistive role to the licensed nurse in the provision of patient/client activities as delegated by the nurse; (2) An individual trained (either on-the-job or through a formal course generally of less than one year) and experienced in performing patient or client-care nursing tasks that do not require the skills of a specialist, technician, or professional. Examples of tasks performed by nurses aides include changing clothes, diapers, and beds; assisting patients to perform exercises or personal hygiene tasks, and supporting communication or social interaction. Specific education and credentials are not required for this work. |
| Healthcare Provider Taxonomy #12 | |
| Healthcare Provider Primary Taxonomy Switch 12 | N |
Primary Taxonomy:
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| Healthcare Provider Taxonomy Code #13 | 385H00000X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 13 | Definition to come. |
| Healthcare Provider Taxonomy #13 | |
| Healthcare Provider Primary Taxonomy Switch 13 | N |
Primary Taxonomy:
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| Healthcare Provider Taxonomy Code #14 | 253Z00000X |
| The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. | |
| Healthcare Provider Taxonomy 14 | An In Home Supportive Care Agency provides services in the patient's home with the goal of enabling the patient to remain at home. The services provided may include personal care services such as hands-on assistance with activities of daily living (ADLs), e.g., eating, bathing, dressing, and bladder and bowel requirements; homemaker services and instrumental activities of daily living (IADLs), e.g., taking medications, shopping for groceries, laundry, housekeeping, and companionship; and/or supervision or cuing so that a person can perform tasks themselves. |
| Healthcare Provider Taxonomy #14 | |
| Healthcare Provider Primary Taxonomy Switch 14 | Y |
Primary Taxonomy:
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