Individual provider Active NPI

Teresa N Roache

  • Family Nurse Practitioner
  • Kingsport, TN
National Provider Identifier
1740680776
Registry record updated Apr 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
18731 Issued in TN
Practice address
1905 American Way Ste 3
Kingsport, TN 37660-5882
Phone
(423) 543-4696
NPI assigned
Aug 27, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 0024184633 VA
Family Nurse Practitioner 363LF0000X 18731 TN Primary

Addresses

Primary practice location

1905 American Way Ste 3
Kingsport, TN 37660-5882

Mailing address

1905 American Way Ste 3
Kingsport, TN 37660-5882
Phone (423) 543-4696

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, VA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20221103003158 TN Practitioner - Nurse Practitioner 9335516335 Reassigns benefits to 1 organization
I20221111001514 VA Practitioner - Nurse Practitioner 9335516335

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
18731TNMDFamily Nurse Practitioner
0024184633VAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Tennessee Oncology PLLC CurrentSince Apr 21, 2025 Accepting new patients

Locations

378 Marketplace Blvd
Ste 6
Johnson City, TN 37604
Phone (423) 568-8320

1750 Cedar Ln
Ste 200
Tullahoma, TN 37388
Phone (615) 333-2481

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1409097600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743552000000",
    "number": "1740680776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1905 AMERICAN WAY STE 3",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376605882",
            "telephone_number": "423-543-4696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1905 AMERICAN WAY STE 3",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376605882",
            "telephone_number": "423-543-4696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROACHE",
        "first_name": "TERESA",
        "middle_name": "N",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-27",
        "last_updated": "2025-04-02",
        "certification_date": "2025-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024184633",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "18731",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingsport, TN

Sources for this page

Verify at the official NPI Registry.