Active NPI
Jordan Scott Nickels
- Family Nurse Practitioner
- Rogersville, TN
National Provider Identifier
1922929504
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 42437
- Practice address
- 300 Park Blvd
Rogersville, TN 37857-2912 - Phone
- (423) 347-6021
- NPI assigned
- Jul 21, 2026
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 0024198030 | VA | |
| Family Nurse Practitioner | 363LF0000X | 42437 | TN | Primary |
Addresses
Primary practice location
300 Park Blvd
Rogersville, TN 37857-2912
Mailing address
300 Park Blvd
Rogersville, TN 37857-2912
Phone (423) 347-6021
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1784592000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1784592000000",
"number": "1922929504",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 PARK BLVD",
"city": "ROGERSVILLE",
"state": "TN",
"postal_code": "378572912",
"telephone_number": "423-347-6021"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 PARK BLVD",
"city": "ROGERSVILLE",
"state": "TN",
"postal_code": "378572912",
"telephone_number": "423-347-6021"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICKELS",
"first_name": "JORDAN",
"middle_name": "SCOTT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2026-07-21",
"last_updated": "2026-07-21",
"certification_date": "2026-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "VA",
"license": "0024198030",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "TN",
"license": "42437",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rogersville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.