Jacqueline Grooms Oliver, PNP-AC

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

32794 Issued in TN

Practice address

329 Wesley St
Johnson City, TN 37601-1772

Phone

(423) 631-0055

NPI assigned

Dec 21, 2015

Last updated

May 20, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• East Tennessee State University

  dba Johnson City Downtown Clinic Day Center

  • Federally Qualified Health Center (FQHC)
  • Johnson City, TN
  • NPI 1093990608
  Medicare reassignment NPD
• East Tennessee State University

  dba Johnson City Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Johnson City, TN
  • NPI 1477660199
  NPD
• Kids First Children's Urgent Care

  • Pediatrics Physician
  • Johnson City, TN
  • NPI 1255046090
  NPD
• East Tennessee State University

  dba Student University Health Services

  • Multi-Specialty Clinic/Center
  • Johnson City, TN
  • NPI 1568570273
  NPD (past)
• Kids Care Pediatrics PA

  • Pediatrics Physician
  • Smithfield, NC
  • NPI 1487612628
  NPD (past)

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

{
    "created_epoch": "1450656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716163200000",
    "number": "1467817353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "329 WESLEY ST",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376011772",
            "telephone_number": "423-631-0055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "329 WESLEY ST",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376011772",
            "telephone_number": "423-631-0055"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2151 Century Ln",
            "address_purpose": "LOCATION",
            "city": "Johnson City",
            "state": "TN",
            "postal_code": "376044469",
            "country_code": "US",
            "telephone_number": "423-926-2500",
            "fax_number": "423-926-5999",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OLIVER",
        "first_name": "JACQUELINE",
        "middle_name": "GROOMS",
        "credential": "PNP-AC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-12-21",
        "last_updated": "2024-05-20",
        "certification_date": "2024-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NC",
            "license": "5008262",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "TN",
            "license": "32794",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Victoria Ola
• Sydney Olds
• Kenneth E. Olive, M.D.
• Brandi Oliver, LPN
• Jacob W Oliver, NP
• Joe Oliver
• Marissa Oliver
• Rozalyn Nichole Oliver, PMHNP-BC
• Allison Franklin Oliviero
• April D Ollis, NP

• Pediatric Nurse Practitioner in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Pediatric Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.