Individual provider Active NPI

Nicole M Miller, MD

  • Pediatrics Physician
  • Gray, TN
National Provider Identifier
1841293560
Registry record updated May 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
MD 29248 Issued in TN
Practice address
115 Judge Gresham Rd Ste B
Gray, TN 37615-6213
Phone
(423) 477-2010
NPI assigned
May 27, 2005
Last updated
May 19, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 19, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X MD 29248 TN Primary

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

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050509000454 TN Practitioner - Pediatric Medicine 3971543075 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD 29248TNMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
State of Franklin Healthcare Associates PLLC Pediatrics CurrentSince Feb 1, 2020 Accepting new patients
Wellmont Medical Associates, Inc. CurrentSince Jul 1, 2025 Accepting new patients
Wellmont Medical Associates Inc Pediatrics CurrentSince Jul 1, 2025 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

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

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

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

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

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1117152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747612800000",
    "number": "1841293560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1021 W OAKLAND AVE STE 310",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376042192",
            "telephone_number": "423-952-2111",
            "fax_number": "423-282-1657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 JUDGE GRESHAM RD STE B",
            "city": "GRAY",
            "state": "TN",
            "postal_code": "376156213",
            "telephone_number": "423-477-2010"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2002 Brookside Dr",
            "address_2": "Suite 200",
            "address_purpose": "LOCATION",
            "city": "Kingsport",
            "state": "TN",
            "postal_code": "376604634",
            "country_code": "US",
            "telephone_number": "423-530-7970",
            "fax_number": "423-232-8581",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MILLER",
        "first_name": "NICOLE",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-05-27",
        "last_updated": "2025-05-19",
        "certification_date": "2025-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TN",
            "license": "MD 29248",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gray, TN

Sources for this page

Verify at the official NPI Registry.