Johnny R Shupe, APRN
Individual provider Active NPI Family Nurse Practitioner · Duffield, VA
NPI 1659495356 · NPPES record last updated Aug 12, 2009
Key facts
- NPI
- 1659495356
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 0024151769 (VA)
- Practice address
- 373 Cecil D Quillen Dr
Suite 101
Duffield, VA 24244-4085 - Phone
- (276) 431-1638
- Fax
- (276) 431-1639
- NPI assigned
- Mar 19, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- University of Tennessee, HSC, College of Medicine, 1993
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Regional Health Resources Inc
Practice addresses (Care Compare)
373 Cecil D Quillen Dr
Duffield, VA 24244-4085
Phone (276) 431-1638
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in 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 |
|---|---|---|---|---|
| I20140204000389 | VA | Practitioner - Nurse Practitioner | 8628960473 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Nurse Specialist, Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Regional Health Resources Inc | Current |
Accepting new patients | |
| Regional Health Resources, Inc | Current |
Accepting new patients | |
| Tricare Behavorial Health, LLC Group | Past | Accepting new patients | |
| Tricare Behavorial Health LLC | Past | Accepting new patients |
Locations
1104 Volunteer Pkwy
Ste 20
Bristol, TN 37620
Phone (423) 989-7755
4022 Fort Henry Dr
Kingsport, TN 37663
Phone (423) 239-2190
2045 Valley View Dr
Big Stone Gap, VA 24219
Phone (276) 523-3000
373 Cecil D Quillen Dr
#101
Duffield, VA 24244
Phone (276) 431-1638
282 Ben Bolt Ave
Tazewell, VA 24651
Phone (276) 582-3510
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 0024151769 | VA | Yes |
Addresses
Primary practice location
373 Cecil D Quillen Dr
Suite 101
Duffield, VA 24244-4085
Mailing address
3609 Hemlock Park Dr
Kingsport, TN 37663-2063
Phone (423) 239-3431
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 007790741 | Medicaid | VA |
Other providers in Duffield, VA
- Ridgecrest Manor Nursing and Rehabilitation, LLC
- Saber Ridgecrest Manor
- Saborah Lee Salvatore
- Lauren Elizabeth Setler
- Julia Eve Shubert
- Travis Shupe
- Brooke Simmons
- Rhonda Faye Simmons
- Regina G Simpson
- Southwest Virginia Home Medical, LLC
All providers in Duffield, VA · Family Nurse Practitioner in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 12, 2009. 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.