Kathleen Rachelle Matteson

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

378 Marketplace Dr Ste 5
Johnson City, TN 37604-2361

Phone

(423) 282-0751

Fax

(423) 282-1577

NPI assigned

Oct 18, 2016

Last updated

Nov 24, 2023By 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 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Blue Ridge Medical Management Corporation

  dba Ballad Health Medical Associates

  • Pediatrics Physician
  • Johnson City, TN
  • NPI 1386028215
  NPD
• Wellmont Medical Associates, Inc.

  dba Ballad Health Medical Associates

  • Internal Medicine Physician
  • Abingdon, VA
  • NPI 1639537525
  NPD
• Wellmont Medical Associates, Inc.

  dba Ballad Health Medical Associates

  • Internal Medicine Physician
  • Johnson City, TN
  • NPI 1154789030
  NPD (past)
• Wellmont Medical Associates Inc

  dba Ballad Health Medical Associates

  • Internal Medicine Physician
  • Abingdon, VA
  • NPI 1174808216
  NPD (past)

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

{
    "created_epoch": "1476748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700784000000",
    "number": "1487105128",
    "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": "378 MARKETPLACE DR STE 5",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376042361",
            "telephone_number": "423-282-0751",
            "fax_number": "423-282-1577"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2461 University Commons Way",
            "address_purpose": "LOCATION",
            "city": "Knoxville",
            "state": "TN",
            "postal_code": "37919",
            "country_code": "US",
            "telephone_number": "865-673-6603",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "108 Park Ave",
            "address_purpose": "LOCATION",
            "city": "Banner Elk",
            "state": "NC",
            "postal_code": "28604",
            "country_code": "US",
            "telephone_number": "828-783-9183",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "111 W Stone Dr Ste 110",
            "address_purpose": "LOCATION",
            "city": "Kingsport",
            "state": "TN",
            "postal_code": "376606027",
            "country_code": "US",
            "telephone_number": "423-224-3701",
            "fax_number": "423-224-3709",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "405 Scenic Dr Ste A",
            "address_purpose": "LOCATION",
            "city": "Rogersville",
            "state": "TN",
            "postal_code": "37857",
            "country_code": "US",
            "telephone_number": "423-921-3490",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2686 W State St",
            "address_purpose": "LOCATION",
            "city": "Bristol",
            "state": "TN",
            "postal_code": "37620",
            "country_code": "US",
            "telephone_number": "423-844-0026",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1497 W Elk Ave Ste 11",
            "address_purpose": "LOCATION",
            "city": "Elizabethton",
            "state": "TN",
            "postal_code": "37643",
            "country_code": "US",
            "telephone_number": "423-542-8929",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "161 Heart Dr",
            "address_purpose": "LOCATION",
            "city": "Johnson City",
            "state": "TN",
            "postal_code": "37604",
            "country_code": "US",
            "telephone_number": "423-282-0751",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "438 E Vann Rd Ste 301",
            "address_purpose": "LOCATION",
            "city": "Greeneville",
            "state": "TN",
            "postal_code": "37743",
            "country_code": "US",
            "telephone_number": "423-787-7496",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "344 Overlook Dr Ste 200",
            "address_purpose": "LOCATION",
            "city": "Lebanon",
            "state": "VA",
            "postal_code": "24266",
            "country_code": "US",
            "telephone_number": "276-883-5900",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4600 Fort Henry Dr",
            "address_purpose": "LOCATION",
            "city": "Kingsport",
            "state": "TN",
            "postal_code": "37663",
            "country_code": "US",
            "telephone_number": "423-224-3950",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MATTESON",
        "first_name": "KATHLEEN",
        "middle_name": "RACHELLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-10-18",
        "last_updated": "2023-11-24",
        "certification_date": "2023-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hunter Mason, MD
• Samuel O Massey III, M.D.
• Erika Masters, NP-C
• Craig Matherne, MD
• Amanda Matney, PHARMD
• Kristine C Matthias, CCC-SLP
• Emilyn Wilson Mattice
• Carol M Maupin-Wheelock, PT,MBA,CERT. MDT
• Ernest David Maupin, DNP, APRN, PMHNP-BC
• Richard Christopher Maupin, PA-C

• Physician Assistant in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Physician Assistant in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2023; 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.