Charla Barefield Bacon, FNP-C
Individual provider Active NPI Family Nurse Practitioner · Johnson City, TN
NPI 1639697188 · NPPES record last updated Mar 18, 2024
Key facts
- NPI
- 1639697188
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 22937 (TN)
- Practice address
- 1018 Chase Dr
Johnson City, TN 37604-1402 - Phone
- (423) 282-3379
- Fax
- (423) 430-6227
- NPI assigned
- Sep 5, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Jason Della Vecchia MD PLLC
Practice addresses (Care Compare)
1700 Pinebrook Dr
Suite 4
Kingsport, TN 37660-4365
Phone (423) 251-6670
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TN, VA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180207001241 | TN | Practitioner - Nurse Practitioner | 8729348065 | Reassigns benefits to 2 organizations |
| I20250305000348 | VA | Practitioner - Nurse Practitioner | 8729348065 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jason Della Vecchia MD PLLC | Current |
Accepting new patients | |
| Emmaus Medical and Counseling, PLLC | Current |
Accepting new patients | |
| Scott County Drug | Past |
Accepting new patients |
Locations
273 Highway 11 E
Bulls Gap, TN 37711
Phone (423) 393-4146
1730 Old Gray Station Rd
Johnson City, TN 37615
Phone (423) 202-3008
1700 Pinebrook Dr
Ste 4
Kingsport, TN 37660
Phone (423) 251-6670
930 Adell Ree Park Ln
Knoxville, TN 37909
Phone (865) 769-2600
3815 Highway 66 S
Ste 4
Rogersville, TN 37857
Phone (423) 922-9211
2834 US Highway 23 North
Weber City, VA 24290
Phone (276) 386-3161
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 22937 | TN | Yes |
Addresses
Primary practice location
1018 Chase Dr
Johnson City, TN 37604-1402
Mailing address
1018 Chase Dr
Johnson City, TN 37604-1402
Phone (423) 282-3379
Other practice location 1
926 W Oakland Ave Ste 206
Johnson City, TN 37604-1445
Phone (423) 282-3379
Other providers in Johnson City, TN
- Borzou Azima
- Back to Health P.C.
- James Steven Backers
- Joanne E Backofen
- Casey E. Bacon
- Kimberly S Bacon
- Paul Ryan Bader
- Kristina Bagley
- Mona Mylene Baharestani
- Anne Bailey
All providers in Johnson City, TN · Family Nurse Practitioner in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 18, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.