Individual provider Active NPI

Niki L Dockery, NP

  • Adult Health Nurse Practitioner
  • Johnson City, TN
National Provider Identifier
1770843583
Registry record updated Feb 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
16709 Issued in TN
Practice address
301 Med Tech Pkwy Ste 240
Johnson City, TN 37604
Phone
(423) 794-5520
Fax
(423) 282-6940
NPI assigned
May 25, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 16709 TN Primary
Adult Health Nurse Practitioner 363LA2200X 0024171734 VA

Addresses

Primary practice location

301 Med Tech Pkwy Ste 240
Johnson City, TN 37604

Mailing address

PO Box 632476
Cincinnati, OH 45263-2476
Phone (423) 794-5520

Other practice location 1

408 N State Of Franklin Rd
Suite 24
Johnson City, TN 37604-6089
Phone (423) 431-1810

Other identifiers 4

IdentifierTypeStateIssuer
1530448MedicaidTN
1770843583MedicaidVA
1770843583MedicaidNC
7100211580MedicaidKY

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120921000482 TN Practitioner - Nurse Practitioner 7315195096 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of Cincinnati College of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
State of Franklin Healthcare Associates, PLLCGroup PAC ID 2466346291, 258 clinicians

Practice addresses (Care Compare)

313 Princeton Rd
Suite 3
Johnson City, TN 37601-2000
Phone (423) 282-5435

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
16709TNMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
State of Franklin Healthcare Associates PLLC CurrentSince Nov 15, 2020 Accepting new patients
Gastrointestinal Associates of Northeast Tennessee, PC CurrentSince Apr 23, 2014 Accepting new patients
State of Franklin Healthcare Associates PLLC CurrentSince Oct 12, 2015 Accepting new patients

Locations

5 Worth Cir
Ste 4
Johnson City, TN 37601
Phone (423) 282-4819

408 N State of Franklin Rd
Ste 24
Johnson City, TN 37604
Phone (423) 431-1810

310 N State of Franklin Rd
Ste 202
Johnson City, TN 37604
Phone (423) 434-3700

313 Princeton Rd
Ste 3
Johnson City, TN 37601
Phone (423) 282-4819

301 Med Tech Pkwy
Ste 240
Johnson City, TN 37604
Phone (423) 794-5520

215 E Springbrook Dr
Johnson City, TN 37601
Phone (423) 530-7900

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/24871/brand/1/csg/1/fhir/r4

Organizations & group practices 3

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1337904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739491200000",
    "number": "1770843583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 632476",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452632476",
            "telephone_number": "423-794-5520",
            "fax_number": "423-282-6940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 MED TECH PKWY STE 240",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "37604",
            "telephone_number": "423-794-5520",
            "fax_number": "423-282-6940"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "408 N State Of Franklin Rd",
            "address_2": "Suite 24",
            "address_purpose": "LOCATION",
            "city": "Johnson City",
            "state": "TN",
            "postal_code": "376046089",
            "country_code": "US",
            "telephone_number": "423-431-1810",
            "fax_number": "423-431-1811",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOCKERY",
        "first_name": "NIKI",
        "middle_name": "L",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-05-25",
        "last_updated": "2025-02-14",
        "certification_date": "2025-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "TN",
            "license": "16709",
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "VA",
            "license": "0024171734",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1530448",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1770843583",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1770843583",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100211580",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnson City, TN

Sources for this page

Verify at the official NPI Registry.