Active NPI
Theron Blickenstaff, M.D.
- Occupational Medicine Physician
- Kingsport, TN
National Provider Identifier
1467640375
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Medicine Physician
- License
- 14559
- Practice address
- 709 Clandon Dr
Kingsport, TN 37660-5036 - Phone
- (423) 378-3267
- NPI assigned
- Oct 5, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Medicine Physician | 2083X0100X | 14559 | TN | Primary |
Addresses
Primary practice location
709 Clandon Dr
Kingsport, TN 37660-5036
Mailing address
709 Clandon Dr
Kingsport, TN 37660-5036
Phone (423) 378-3267
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 14559 | TN | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1191542400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1191542400000",
"number": "1467640375",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "709 CLANDON DR",
"city": "KINGSPORT",
"state": "TN",
"postal_code": "376605036",
"telephone_number": "423-378-3267"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "709 CLANDON DR",
"city": "KINGSPORT",
"state": "TN",
"postal_code": "376605036",
"telephone_number": "423-378-3267"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLICKENSTAFF",
"first_name": "THERON",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-10-05",
"last_updated": "2007-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "2083X0100X",
"taxonomy_group": "",
"desc": "Preventive Medicine, Occupational Medicine",
"state": "TN",
"license": "14559",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kingsport, TN
- Savannah Rasnic Bledsoe
- Tara Bledsoe, APN
- Whitney Grace Blessing, PHARMD
- Serena Elizabeth Blevins, FNP
- Summer Kylene Blevins, BS
- Bloomingdale Drug of Kingsport, LLC
- Blue Ridge Medical Management
- Blue Ridge Medical Management Corp
- Blue Ridge Medical Management Corp
- Blue Ridge Medical Management Corporation
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.