Individual provider Active NPI

Callie E. Tankersley, NP

  • Family Nurse Practitioner
  • Kingsport, TN
National Provider Identifier
1932575958
Registry record updated Jan 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
20506 Issued in TN
Practice address
105 W Stone Dr Ste 1F
Kingsport, TN 37660-3365
Phone
(423) 230-2420
NPI assigned
Aug 13, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 169201 TN
Family Nurse Practitioner 363LF0000X 0024173100 VA
Family Nurse Practitioner 363LF0000X 20506 TN Primary

Addresses

Primary practice location

105 W Stone Dr Ste 1F
Kingsport, TN 37660-3365

Mailing address

PO Box 9
Kingsport, TN 37662-0009

Other practice location 1

111 W Stone Dr
Suite 110
Kingsport, TN 37660-6027
Phone (423) 224-3701

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, VA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20151106000136 TN Practitioner - Nurse Practitioner 7810207685 Reassigns benefits to 2 organizations
I20160122000685 VA Practitioner - Nurse Practitioner 7810207685 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Holston Medical Group PCGroup PAC ID 8224935754, 239 clinicians

Practice addresses (Care Compare)

105 W Stone Dr
Suite 1F
Kingsport, TN 37660-3256
Phone (423) 230-2420

641 Campus Dr
Abingdon, VA 24210-9700
Phone (276) 739-2900

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
169201TNMDRegistered Nurse
20506TNMDFamily Nurse Practitioner
0024173100VAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Holston Medical Group PC CurrentSince Feb 27, 2020 Accepting new patients
Wellmont Medical Associates Inc CurrentSince Oct 8, 2015 Accepting new patients

Locations

350 Steeles Rd
#1
Bristol, TN 37620
Phone (423) 844-4925

105 W Stone Dr
Ste 6A
Kingsport, TN 37660
Phone (423) 408-7220

105 W Stone Dr
Ste 1F
Kingsport, TN 37660
Phone (423) 230-2420

111 W Stone Dr
Ste 100
Kingsport, TN 37660
Phone (423) 247-5197

111 W Stone Dr
Ste 110
Kingsport, TN 37660
Phone (423) 224-3701

631 Campus Dr
Abingdon, VA 24210
Phone (276) 676-3870

641 Campus Dr
Abingdon, VA 24210
Phone (276) 739-2900

391 Falls Dr NW
Abingdon, VA 24210
Phone (276) 628-4406

495 E Main St
Lebanon, VA 24266
Phone (276) 889-3700

Interoperability endpoints

  • Direct secure messaging: callietankersley@hmgpath.allscriptsdirect.net

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1439424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611187200000",
    "number": "1932575958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376620009",
            "fax_number": "423-408-7405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 W STONE DR STE 1F",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376603365",
            "telephone_number": "423-230-2420"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "111 W Stone Dr",
            "address_2": "Suite 110",
            "address_purpose": "LOCATION",
            "city": "Kingsport",
            "state": "TN",
            "postal_code": "376606027",
            "country_code": "US",
            "telephone_number": "423-224-3701",
            "fax_number": "423-224-3709",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TANKERSLEY",
        "first_name": "CALLIE",
        "middle_name": "E.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-13",
        "last_updated": "2021-01-21",
        "certification_date": "2021-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TN",
            "license": "169201",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024173100",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "20506",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingsport, TN

Sources for this page

Verify at the official NPI Registry.