Individual provider Active NPI

Jacqueline Carol Dotson, FNP-BC

  • Family Nurse Practitioner
  • Sevierville, TN
National Provider Identifier
1104309681
Registry record updated Jul 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APN24531 Issued in TN
Practice address
641 Middle Creek Rd
Sevierville, TN 37862-5014
Phone
(865) 428-0583
NPI assigned
Sep 11, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X RN176793 TN
Family Nurse Practitioner 363LF0000X APN24531 TN Primary

Addresses

Primary practice location

641 Middle Creek Rd
Sevierville, TN 37862-5014

Mailing address

1275 Dick Lonas Rd
Knoxville, TN 37909-1382
Phone (865) 584-4747

Other names 1

  • Jacqueline Carol Crockett Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181015003592 TN Practitioner - Nurse Practitioner 6901158294 Reassigns benefits to 4 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
RN176793TNMDRegistered Nurse
APN24531TNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Cherokee Health Systems CurrentSince Sep 10, 2018 Accepting new patients
Signify Health Medical Associates, PLLC CurrentSince May 31, 2024 Accepting new patients
Summit Medical Group, PLLC CurrentSince Aug 1, 2019 Accepting new patients
Cherokee Health Systems CurrentSince Sep 10, 2018 Accepting new patients
Magnolia Family Practice LLC CurrentSince Oct 1, 2022 Accepting new patients
Summit Medical Group, PLLC CurrentSince Aug 1, 2019 Accepting new patients

Locations

255 E Watt St
Alcoa, TN 37701
Phone (865) 273-1616

1225 E Weisgarber Rd
Ste 200
Knoxville, TN 37909
Phone (865) 938-3627

6336 Chapman Hwy
Knoxville, TN 37920
Phone (865) 880-0857

300 Montvue Rd
Knoxville, TN 37919
Phone (818) 613-6769

103 Midlake Dr
Lowr
Knoxville, TN 37918
Phone (865) 470-2696

641 Middle Creek Rd
Sevierville, TN 37862
Phone (865) 428-0583

6350 W Andrew Johnson Hwy
Talbott, TN 37877
Phone (423) 586-5031

6350 W Andrew Johnson Hwy
#100
Talbott, TN 37877
Phone (423) 586-5031

4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/23911/brand/1/csg/1/fhir/r4

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1536624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625184000000",
    "number": "1104309681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1275 DICK LONAS RD",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379091382",
            "telephone_number": "865-584-4747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "641 MIDDLE CREEK RD",
            "city": "SEVIERVILLE",
            "state": "TN",
            "postal_code": "378625014",
            "telephone_number": "865-428-0583"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOTSON",
        "first_name": "JACQUELINE",
        "middle_name": "CAROL",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-11",
        "last_updated": "2021-07-02",
        "certification_date": "2021-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TN",
            "license": "RN176793",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "APN24531",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "CROCKETT",
            "middle_name": "CAROL",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Sevierville, TN

Sources for this page

Verify at the official NPI Registry.