Jerry Don Walkup Jr., M.D.

Primary specialty

Pediatric Cardiology PhysicianTaxonomy code 2080P0202X

License

0101256238 Issued in VA

Practice address

2312 Knob Creek Rd Ste 208
Johnson City, TN 37604-2367

Phone

(423) 610-1099

Fax

(423) 246-4300

NPI assigned

May 17, 2011

Sex

Male

Sole proprietor

Yes

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

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Tri-City Pediactric Cardiology P C

  • Pediatric Cardiology Physician
  • Johnson City, TN
  • NPI 1841362555

  Single Specialty

  Medicare reassignment NPD
• Regional Allergy & Asthma Center, PC

  • Specialist
  • Kingsport, TN
  • NPI 1174581854

  Single Specialty

  NPD

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

{
    "created_epoch": "1305590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721174400000",
    "number": "1578856985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2312 KNOB CREEK RD STE 208",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376042367",
            "telephone_number": "423-610-1099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2312 KNOB CREEK RD STE 208",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376042367",
            "telephone_number": "423-610-1099",
            "fax_number": "423-246-4300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1490 Park Ave NW # 4B-2",
            "address_purpose": "LOCATION",
            "city": "Norton",
            "state": "VA",
            "postal_code": "242731631",
            "country_code": "US",
            "telephone_number": "423-610-1099",
            "fax_number": "423-246-4300",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "935 Wilcox Ct Ste 150",
            "address_purpose": "LOCATION",
            "city": "Kingsport",
            "state": "TN",
            "postal_code": "376605183",
            "country_code": "US",
            "telephone_number": "423-610-1099",
            "fax_number": "423-246-4300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALKUP",
        "first_name": "JERRY",
        "middle_name": "DON",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-05-17",
        "last_updated": "2024-07-17",
        "certification_date": "2024-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "VA",
            "license": "0101256238",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Walgreen Co.
• Dakota Walker, FNP-BC
• Denise Walker
• Erica Walker, MSW
• Sabrina M Walker
• Logan Lauderdale Wallace, MD
• Marty Dale Wallace, CRNA
• Deborah Lynn Wallen, BSW
• Joseph Jeffrey Wallen, M.D.
• Erin Beth Walls

• Pediatric Cardiology Physician in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Pediatric Cardiology Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 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.