NPIMap

Individual provider Active NPI

Nina Lisette De Vilmorin, MD

  • Anesthesiology Physician
  • Kingsport, TN
National Provider Identifier
1295774750
Registry record updated Aug 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
74578 Issued in TN
Practice address
10415 Wallace Alley St
Kingsport, TN 37663-3936
Phone
(423) 390-0451
NPI assigned
Jun 6, 2006
Last updated
Aug 4, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 2015-01341 NC
Anesthesiology Physician 207L00000X 148229 MT
Anesthesiology Physician 207L00000X 74578 TN Primary

Addresses

Primary practice location

10415 Wallace Alley St
Kingsport, TN 37663-3936

Mailing address

PO Box 603366
Charlotte, NC 28260-3366
Phone (240) 566-1600

Other practice location 1

509 Biltmore Ave
Asheville, NC 28801-4601
Phone (828) 213-2325

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, MT, TN, NY4 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
I20150924002799 NC Practitioner - Anesthesiology 6709940356
I20250207002067 MT Practitioner - Anesthesiology 6709940356 Reassigns benefits to 1 organization
I20250611001340 TN Practitioner - Anesthesiology 6709940356 Reassigns benefits to 1 organization
I20260205000944 NY Practitioner - Anesthesiology 6709940356 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
California University of Science and Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Paragon Anesthesia PCGroup PAC ID 8921044744, 214 clinicians
Benefis Hospitals IncGroup PAC ID 1153235296, 390 clinicians
Albany Medical CollegeGroup PAC ID 1759293111, 1,054 clinicians

Practice addresses (Care Compare)

1 Medical Park Blvd
Bristol, TN 37620-7430
Phone (423) 390-0451

1101 26TH St S
Great Falls, MT 59405-5161
Phone (406) 455-5000

43 New Scotland Ave
Albany, NY 12208-3412
Phone (518) 262-3277

47 New Scotland Ave
Albany, NY 12208-3412
Phone (518) 262-5633

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
340016NYMDLicensed Practical Nurse
2015-01341NCMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Albany Medical College CurrentSince Dec 16, 2025 Accepting new patients
Albany Medical College Anesthesiology CurrentSince Dec 16, 2025 Accepting new patients
Paragon Anesthesia PC Anesthesiology CurrentSince May 29, 2025 Accepting new patients
East Tennessee Ambulatory Surgery Center LLC CurrentSince May 29, 2025 Accepting new patients
Benefis Hospitals Inc CurrentSince Feb 1, 2025 Accepting new patients
Amsol Physicians of Elkin NC Anesthesiology CurrentSince Aug 3, 2015 Accepting new patients
Benefis Hospitals, Inc. CurrentSince Feb 1, 2025 Accepting new patients
Morpheus Anesthesia Inc Anesthesiology Past Accepting new patients
American Anesthesiology of South Carolina, LLC Anesthesiology Past Accepting new patients
Au Medical Associates Anesthesia Billing Services, LLC Anesthesiology Past Accepting new patients
Delta Radiology, Inc. Past Accepting new patients

Locations

1101 26th St S
Great Falls, MT 59405
Phone (406) 455-4690

1101 26th St S
Fl 5
Great Falls, MT 59405
Phone (406) 455-2132

1401 25th St S
Great Falls, MT 59405
Phone (406) 455-3650

180 Parkwood Dr
Elkin, NC 28621
Phone (336) 527-7000

47 New Scotland Ave
Albany, NY 12208
Phone (518) 262-3773

1 Medical Park Blvd
Bristol, TN 37620
Phone (423) 390-0451

10415 Wallace Alley St
Kingsport, TN 37663
Phone 4233900451 ext. 00451

Organizations & group practices 11

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

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754265600000",
    "number": "1295774750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 603366",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282603366",
            "telephone_number": "240-566-1600",
            "fax_number": "240-566-1605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10415 WALLACE ALLEY ST",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376633936",
            "telephone_number": "423-390-0451"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "509 Biltmore Ave",
            "address_purpose": "LOCATION",
            "city": "Asheville",
            "state": "NC",
            "postal_code": "288014601",
            "country_code": "US",
            "telephone_number": "828-213-2325",
            "fax_number": "828-213-2311",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DE VILMORIN",
        "first_name": "NINA",
        "middle_name": "LISETTE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-06",
        "last_updated": "2025-08-04",
        "certification_date": "2025-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NC",
            "license": "2015-01341",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MT",
            "license": "148229",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "TN",
            "license": "74578",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingsport, TN

Sources for this page

Verify at the official NPI Registry.