Deronna S Moore, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2543 Issued in TN

Practice address

111 W Stone Dr Ste 110
Kingsport, TN 37660-6027

Phone

(423) 224-3701

NPI assigned

Jun 6, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in TN, VA2 enrollments

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 2

Specialty

Physician Assistant

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wellmont Medical Associates IncGroup PAC ID 8123291739, 432 clinicians

Weaver MedicalGroup PAC ID 0143666115, 3 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Greeneville Community Hospital Hospital, Greeneville, TN, CCN 440050
• Hawkins County Memorial Hospital Hospital, Rogersville, TN, CCN 440032

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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 and National Provider Directory roles.

• Weaver Medical

  • Family Medicine Physician
  • Morristown, TN
  • NPI 1588383350
  Medicare reassignment Care Compare group
• Wellmont Medical Associates Inc

  • Pulmonary Disease Physician
  • Kingsport, TN
  • NPI 1780986257
  Medicare reassignment Care Compare group
• Wellmont Medical Associates Inc

  • Family Medicine Physician
  • Big Stone Gap, VA
  • NPI 1174808216
  Medicare reassignment NPD
• Krystal Elizabeth Weaver, PA-C

  • Physician Assistant
  • Morristown, TN
  • NPI 1992152144
  Medicare reassignment
• Blue Ridge Medical Management Corporation

  • Internal Medicine Physician
  • Greeneville, TN
  • NPI 1508430851
  NPD
• Blue Ridge Medical Management Corporation

  • Family Medicine Physician
  • Johnson City, TN
  • NPI 1982553756
  NPD
• Wellmont Medical Associates, Inc.

  • Psychiatry Physician
  • Johnson City, TN
  • NPI 1275393522
  NPD
• Bean Station Family Medicine, PC

  • Primary Care Clinic/Center
  • Bean Station, TN
  • NPI 1255594487
  NPD (past)

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

• Takoma Regional Hospital Inc

  • General Acute Care Hospital
  • Greeneville, TN
  • NPI 1699819003
  Care Compare affiliation
• Wellmont Hawkins County Memorial Hospital Inc

  • General Acute Care Hospital
  • Rogersville, TN
  • NPI 1174553598
  Care Compare affiliation

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

{
    "created_epoch": "1402012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749427200000",
    "number": "1487067534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1021 W OAKLAND AVE STE 310",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376042192",
            "telephone_number": "423-302-6565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 W STONE DR STE 110",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376606027",
            "telephone_number": "423-224-3701"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1497 W Elk Ave Ste 11",
            "address_purpose": "LOCATION",
            "city": "Elizabethton",
            "state": "TN",
            "postal_code": "376432896",
            "country_code": "US",
            "telephone_number": "423-542-8929",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4600 Fort Henry Dr",
            "address_purpose": "LOCATION",
            "city": "Kingsport",
            "state": "TN",
            "postal_code": "376632617",
            "country_code": "US",
            "telephone_number": "423-224-3950",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "115 Judge Gresham Rd Ste A",
            "address_purpose": "LOCATION",
            "city": "Gray",
            "state": "TN",
            "postal_code": "376156213",
            "country_code": "US",
            "telephone_number": "423-467-3000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "24530 Falcon Place Blvd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Abingdon",
            "state": "VA",
            "postal_code": "242117665",
            "country_code": "US",
            "telephone_number": "276-619-0075",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1220 Volunteer Pkwy",
            "address_purpose": "LOCATION",
            "city": "Bristol",
            "state": "TN",
            "postal_code": "376204628",
            "country_code": "US",
            "telephone_number": "423-274-6610",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "405 Scenic Dr Ste A",
            "address_purpose": "LOCATION",
            "city": "Rogersville",
            "state": "TN",
            "postal_code": "378572441",
            "country_code": "US",
            "telephone_number": "423-921-3490",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "438 E Vann Rd Ste 301",
            "address_purpose": "LOCATION",
            "city": "Greeneville",
            "state": "TN",
            "postal_code": "377437202",
            "country_code": "US",
            "telephone_number": "423-636-9828",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2686 W State St",
            "address_purpose": "LOCATION",
            "city": "Bristol",
            "state": "TN",
            "postal_code": "376201817",
            "country_code": "US",
            "telephone_number": "423-844-0026",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "161 Heart Dr Ste A",
            "address_purpose": "LOCATION",
            "city": "Johnson City",
            "state": "TN",
            "postal_code": "376042607",
            "country_code": "US",
            "telephone_number": "423-282-0751",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "231 S Fairmont Ave",
            "address_purpose": "LOCATION",
            "city": "Morristown",
            "state": "TN",
            "postal_code": "378132036",
            "country_code": "US",
            "telephone_number": "423-839-1600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOORE",
        "first_name": "DERONNA",
        "middle_name": "S",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-06",
        "last_updated": "2025-06-09",
        "certification_date": "2025-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110009681",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KY",
            "license": "1903",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "2543",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leah Nicole Moon, MD
• Soon Moon, DO
• Mary Rebecca Mooney, PT
• Candeda Sha Moore, PHARMD
• Christy L Moore, NP
• Donna D Moore, CRNA
• Christopher Morelock, FNP
• Kyle J Morgan, PA
• Michael Morgan, OD
• David J Morin, MD

• Physician Assistant in Kingsport, TN
• Providers in Kingsport, TN by specialty
• Physician Assistant in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.