Dawn M Nuckolls, DO

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

DO2590 Issued in TN

Practice address

301 Med Tech Pkwy
Suite 240
Johnson City, TN 37604

Phone

(423) 794-5520

Fax

(423) 282-0720

NPI assigned

Jun 29, 2012

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

Other identifiers 2

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Internal Medicine

Education

Lincoln Memorial University Medical Department, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

State of Franklin Healthcare Associates, PLLCGroup PAC ID 2466346291, 258 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ballad Health Homecare Home health agency, Johnson City, TN, CCN 447240
• Ballad Health Hospice Hospice, Bristol, TN, CCN 441558
• Franklin Woods Community Hospital Hospital, Johnson City, TN, CCN 440184
• Johnson City Medical Center Hospital, Johnson City, TN, CCN 440063
• Wellmont Bristol Regional Medical Center Hospital, Bristol, TN, CCN 440012

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/24871/brand/1/csg/1/fhir/r4

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.

• State of Franklin Healthcare Associates PLLC

  • Internal Medicine Physician
  • Johnson City, TN
  • NPI 1063459410
  Medicare reassignment Care Compare group NPD
• Medical Education Assistance Corporation

  dba ETSU Physicians and Associates

  • Internal Medicine Physician
  • Johnson City, TN
  • NPI 1235180480
  Medicare reassignment NPD
• State of Franklin Healthcare Associates PLLC

  • Clinical Medical Laboratory
  • Johnson City, TN
  • NPI 1841846136
  NPD (past)

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

• Mountain States Health Alliance

  dba Woodridge Hospital

  • Psychiatric Hospital Unit
  • Johnson City, TN
  • NPI 1023434339
  Care Compare affiliation
• Mountain States Health Alliance

  dba Ballad Health Hospice

  • Inpatient Hospice
  • Bristol, TN
  • NPI 1033605886
  Care Compare affiliation
• Mountain States Health Alliance

  dba Franklin Woods Community Hospital

  • General Acute Care Hospital
  • Johnson City, TN
  • NPI 1114033628
  Care Compare affiliation
• Mountain States Health Alliance

  dba Ballad Health Homecare

  • Home Health Agency
  • Johnson City, TN
  • NPI 1417030404
  Care Compare affiliation
• Mountain States Health Alliance

  dba Johnson City Medical Center

  • Psychiatric Hospital Unit
  • Johnson City, TN
  • NPI 1962915652
  Care Compare affiliation
• Mountain States Health Alliance

  dba Johnson City Medical Center

  • General Acute Care Hospital
  • Johnson City, TN
  • NPI 1972606465
  Care Compare affiliation
• Wellmont Health System

  dba Bristol Regional Medical Center

  • General Acute Care Hospital
  • Bristol, TN
  • NPI 1124058615
  Care Compare affiliation

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

{
    "created_epoch": "1340928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740009600000",
    "number": "1508120908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 632476",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452632476",
            "telephone_number": "423-794-5520",
            "fax_number": "423-282-6940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 MED TECH PKWY",
            "address_2": "SUITE 240",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "37604",
            "telephone_number": "423-794-5520",
            "fax_number": "423-282-0720"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "917 W Market St",
            "address_purpose": "LOCATION",
            "city": "Johnson City",
            "state": "TN",
            "postal_code": "376045330",
            "country_code": "US",
            "telephone_number": "423-439-6464",
            "fax_number": "423-439-7118",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NUCKOLLS",
        "first_name": "DAWN",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-29",
        "last_updated": "2025-02-20",
        "certification_date": "2025-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TN",
            "license": "DO2590",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q013768",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1508120908",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Northland Hearing Centers, Inc.
• Savannah Brooke Norton, BS
• A Suzanne Norwood, FNP-C
• Nput LLC
• Nu-Liferx, LLC (Nu-LifeRx)
• Manisha Nukavarapu
• Holly Renee Nummerdor, DO
• Jaylah Cheval Nunez-Radden
• Ibis Danitzia Nunez-Santiago, PHD
• Alisa F Nunley, BSS

• Internal Medicine Physician in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Internal Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 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.