Nicole M Miller, MD
Individual provider Active NPI Pediatrics Physician · Gray, TN
NPI 1841293560 · NPPES record last updated May 19, 2025
Key facts
- NPI
- 1841293560
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- MD 29248 (TN)
- Practice address
- 115 Judge Gresham Rd Ste B
Gray, TN 37615-6213 - Phone
- (423) 477-2010
- NPI assigned
- May 27, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050509000454 | TN | Practitioner - Pediatric Medicine | 3971543075 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD 29248 | TN | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wellmont Medical Associates, Inc. | Current |
Accepting new patients | |
| State of Franklin Healthcare Associates PLLC | Pediatrics | Current |
Accepting new patients |
| Wellmont Medical Associates Inc | Pediatrics | Current |
Accepting new patients |
| Mountain States Health Alliance | Past | Accepting new patients | |
| Blue Ridge Medical Management Corporation | Past | Accepting new patients |
Locations
115 Judge Gresham Rd
Ste B
Gray, TN 37615
Phone (423) 477-2010
313 Princeton Rd
Ste 3
Johnson City, TN 37601
Phone (423) 282-4819
1021 W Oakland Ave
Ste 310
Johnson City, TN 37604
Phone (423) 302-6565
215 E Springbrook Dr
Johnson City, TN 37601
Phone (423) 530-7900
111 W Stone Dr
Ste 100
Kingsport, TN 37660
Phone (423) 247-5197
2002 Brookside Dr
Ste 200
Kingsport, TN 37660
Phone (423) 224-3933
Interoperability endpoints
- https://api.platform.athenahealth.com/24871/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | MD 29248 | TN | Yes |
Addresses
Primary practice location
115 Judge Gresham Rd Ste B
Gray, TN 37615-6213
Mailing address
1021 W Oakland Ave Ste 310
Johnson City, TN 37604-2192
Phone (423) 952-2111
Other practice location 1
2002 Brookside Dr
Suite 200
Kingsport, TN 37660-4634
Phone (423) 530-7970
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841293560 | Medicaid | VA | |
| Q003271 | Medicaid | TN |
Other providers in Gray, TN
- Leslie Anne Lowe Meade
- Medical Education Assistance Corporation
- Medical Education Assistance Corporation
- Mediserve Medical Equipment of Kingsport, Inc.
- Michael a. Wolf
- Craig Paul Moorhouse
- Sarah Morgan
- Leah Moseley
- Mountain Wings; LLC
- Elizabeth Brezina Palmer
All providers in Gray, TN · Pediatrics Physician in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 19, 2025. 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.