Active NPI
Deanna L Patterson, FNP
- Family Nurse Practitioner
- Kingsport, TN
National Provider Identifier
1639133473
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- APN07770
- Practice address
- 2000 Brookside Dr
3Rd Floor
Kingsport, TN 37660-4627 - Phone
- (423) 857-5905
- Fax
- (423) 857-5904
- NPI assigned
- Apr 17, 2006
- Last updated
- Dec 23, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | APN07770 | TN | Primary |
| Family Nurse Practitioner | 363LF0000X | RN119860 | TN |
Addresses
Primary practice location
2000 Brookside Dr
3Rd Floor
Kingsport, TN 37660-4627
Mailing address
2000 Brookside Dr
3Rd Floor
Kingsport, TN 37660-4627
Phone (423) 857-5905
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| TN01Q6 | Other | TN | JOHN DEERE |
| 3905386 | Medicaid | TN | |
| 1514467 | Medicaid | TN | |
| 4057118 | Other | TN | BCBS |
| 7100111530 | Medicaid | KY | |
| 1639133473 | Medicaid | VA | |
| P00817727 | Other | TN | RR MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science - Nursing
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| APN07770 | TN | MD | Family Nurse Practitioner |
| RN119860 | TN | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Blue Ridge Medical Management Corporation | Past | Accepting new patients |
Organizations & group practices 1
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.
-
dba Ballad Health Medical Associates
- Hospitalist Physician
- Kingsport, TN
- NPI 1326086224
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145232000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1419292800000",
"number": "1639133473",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2000 BROOKSIDE DR",
"address_2": "3RD FLOOR",
"city": "KINGSPORT",
"state": "TN",
"postal_code": "376604627",
"telephone_number": "423-857-5905",
"fax_number": "423-857-5904"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2000 BROOKSIDE DR",
"address_2": "3RD FLOOR",
"city": "KINGSPORT",
"state": "TN",
"postal_code": "376604627",
"telephone_number": "423-857-5905",
"fax_number": "423-857-5904"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PATTERSON",
"first_name": "DEANNA",
"middle_name": "L",
"credential": "FNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-04-17",
"last_updated": "2014-12-23",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "TN",
"license": "APN07770",
"primary": true
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "TN",
"license": "RN119860",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "JOHN DEERE",
"identifier": "TN01Q6",
"state": "TN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3905386",
"state": "TN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1514467",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "4057118",
"state": "TN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7100111530",
"state": "KY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1639133473",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "P00817727",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Kingsport, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.