Heather L Coburn, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA01205 Issued in TN

Practice address

1019 W Oakland Ave
Suite 1
Johnson City, TN 37604

Phone

(423) 915-5000

Fax

(423) 915-5045

NPI assigned

Apr 22, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Heather L Keene Former name

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

Specialty

Physician Assistant

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wellmont Medical Associates IncGroup PAC ID 8123291739, 432 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Wellmont Medical Associates Inc

  dba Ballad Health Medical Associates

  • Pulmonary Disease Physician
  • Kingsport, TN
  • NPI 1780986257
  Medicare reassignment Care Compare group
• Blue Ridge Medical Management Corporation

  dba Ballad Health Medical Associates

  • Internal Medicine Physician
  • Johnson City, TN
  • NPI 1356472880
  NPD
• Blue Ridge Medical Management Corporation

  dba Ballad Health Medical Associates

  • Family Medicine Physician
  • Johnson City, TN
  • NPI 1982553756
  NPD
• Wellmont Medical Associates, Inc.

  dba Ballad Health Medical Associates

  • Psychiatry Physician
  • Johnson City, TN
  • NPI 1275393522
  NPD
• Wellmont Medical Associates, Inc.

  dba Ballad Health Medical Associates

  • Internal Medicine Physician
  • Bristol, TN
  • NPI 1558812198
  NPD
• Blue Ridge Medical Management Corporation

  dba MSMG Im Eliz

  • Internal Medicine Physician
  • Elizabethton, TN
  • NPI 1619102167
  NPD (past)
• Wellmont Medical Associates, Inc.

  dba Ballad Health Medical Associates

  • Internal Medicine Physician
  • Johnson City, TN
  • NPI 1154789030
  NPD (past)

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

{
    "created_epoch": "1145664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528070400000",
    "number": "1932165545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1019 W OAKLAND AVE",
            "address_2": "SUITE 1",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376042357",
            "telephone_number": "423-915-5000",
            "fax_number": "423-915-5045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1019 W OAKLAND AVE",
            "address_2": "SUITE 1",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "37604",
            "telephone_number": "423-915-5000",
            "fax_number": "423-915-5045"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "378 Marketplace Dr Ste 5",
            "address_purpose": "LOCATION",
            "city": "Johnson City",
            "state": "TN",
            "postal_code": "376042361",
            "country_code": "US",
            "telephone_number": "423-282-0751",
            "fax_number": "423-282-1577",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COBURN",
        "first_name": "HEATHER",
        "middle_name": "L",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-22",
        "last_updated": "2018-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TN",
            "license": "PA01205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1932165545",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q003283",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HEATHER",
            "last_name": "KEENE",
            "middle_name": "L",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• David R Clopton, M.D.
• Deborah G Cloyd, LPC
• Anita Diane Cobble, MD
• Patricia G Coble
• Gordon Coburn, APRN, BC
• Linda Sue Coeburn, LCSW
• Tyler Coffey, RPH
• Harriet Coggan, PT, DPT
• Jerome J Cohan, NP
• Weston Blake Colbaugh, MD

• Medical Physician Assistant in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Medical Physician Assistant in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2018; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.