Jonesborough Medical PLLC

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

License

APN6456 Issued in TN

Legal business name

JONESBOROUGH MEDICAL PLLC

Practice address

1003 E Jackson Blvd
Jonesborough, TN 37659-1538

Phone

(423) 753-6077

NPI assigned

May 8, 2007

Last updated

Jan 6, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mousa NaseriNPI 1043375827

Title

Owner

Phone

(423) 753-6077

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mousa K Naseri, FNP

  • Family Nurse Practitioner
  • Limestone, TN
  • NPI 1043375827
  NPD Authorized official
• Lamiae Nfissi, NP

  • Family Nurse Practitioner
  • Greeneville, TN
  • NPI 1720854102
  NPD (past)
• Adrianne Gabrielle Valerie Vandiver, APRN

  • Nurse Practitioner
  • Jonesborough, TN
  • NPI 1467165431
  NPD (past)

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

{
    "created_epoch": "1178582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672963200000",
    "number": "1841403243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1003 E JACKSON BLVD",
            "city": "JONESBOROUGH",
            "state": "TN",
            "postal_code": "376591538",
            "telephone_number": "423-753-6077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1003 E JACKSON BLVD",
            "city": "JONESBOROUGH",
            "state": "TN",
            "postal_code": "376591538",
            "telephone_number": "423-753-6077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JONESBOROUGH MEDICAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-08",
        "last_updated": "2023-01-06",
        "certification_date": "2023-01-06",
        "status": "A",
        "authorized_official_last_name": "NASERI",
        "authorized_official_first_name": "MOUSA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "423-753-6077"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "TN",
            "license": "APN6456",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael E Jewett, M.D.
• Katlynn Lee Johnson, IBCLC
• Jonesborough Adult & Geriatric Medicine LLC
• Jonesborough Drug
• Jonesborough Eye Clinic, PLLC
• K-VA-T Food Stores Inc (Food City Pharmacy)
• William E. Kennedy, M.D.
• Marissa Kirchenbauer, FNP-C
• Monica Egan Knowles, D.C.
• Jeanna Lee Kovac, LICSW

• Preferred Provider Organization in Jonesborough, TN
• Providers in Jonesborough, TN by specialty
• Preferred Provider Organization in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.