Jackie A Church, APN in Kingsport, TN - Medicare Nurse Practitioner

Jackie A Church, APN is a medicare enrolled "Nurse Practitioner - Family" in Kingsport, Tennessee. She graduated from nursing school in 2006 and has 18 years of diverse experience with area of expertise as Nurse Practitioner. She is a member of the group practice Blue Ridge Medical Management Corporation, Blue Ridge Medical Management Corporation and her current practice location is 4600 Fort Henry Dr, Kingsport, Tennessee. You can reach out to her office (for appointments etc.) via phone at (423) 224-3950.

Jackie A Church is licensed to practice in Tennessee (license number APN12537) and she also participates in the medicare program. She accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1629126321.

Contact Information

	Jackie A Church, APN
	4600 Fort Henry Dr, Kingsport, TN 37663-2617
	(423) 224-3950
	Not Available

Map and Direction

Provider's Profile

Full Name	Jackie A Church
Gender	Female
Speciality	Nurse Practitioner
Experience	18 Years
Location	4600 Fort Henry Dr, Kingsport, Tennessee
Accepts Medicare Assignments	Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.

Medical Education and Training:

Jackie A Church graduated from nursing school in 2006

NPI Data:

NPI Number: 1629126321
Provider Enumeration Date: 01/08/2007
Last Update Date: 10/18/2023

Medicare PECOS Information:

PECOS PAC ID: 1153420195
Enrollment ID: I20070615000550

Medical Identifiers

Medical identifiers for Jackie A Church such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1629126321	NPI	-	NPPES
P01171831	Other	TN	RR MEDICARE
1629126321	Medicaid	NC
1629126321	Medicaid	VA
3341016	Medicaid	TN
7100236150	Medicaid	KY

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
163W00000X	Registered Nurse	143764 (Tennessee)	Secondary
363L00000X	Nurse Practitioner	0024187900 (Virginia)	Secondary
363L00000X	Nurse Practitioner	5018685 (North Carolina)	Secondary
363LF0000X	Nurse Practitioner - Family	APN12537 (Tennessee)	Primary

Group Practice Association

Group Practice Name	Group PECOS PAC ID	No. of Members
Blue Ridge Medical Management Corporation	9739099441	280
Blue Ridge Medical Management Corporation	9739099441	280

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Jackie A Church allows following entities to bill medicare on her behalf.

Entity Name	Blue Ridge Medical Management Corporation
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1144380833 PECOS PAC ID: 9739099441 Enrollment ID: O20031204000996

Entity Name	Medical Care Pllc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1851537260 PECOS PAC ID: 1850448580 Enrollment ID: O20090414000752

Entity Name	Tri-cities Regional Emergency Physicians, Pc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1063950046 PECOS PAC ID: 3678859477 Enrollment ID: O20170410002399

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jackie A Church is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Jackie A Church, APN 1021 W Oakland Ave Ste 310, Johnson City, TN 37604-2192 Ph: (423) 302-6565	Jackie A Church, APN 4600 Fort Henry Dr, Kingsport, TN 37663-2617 Ph: (423) 224-3950

Reviews and Comments

Nurse Practitioner Nurses in Kingsport, TN

Mrs. Cathy A Greenwood, FNP-BC Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 3136 Winesap Rd, Kingsport, TN 37663 Phone: 423-726-2077
Lauren Ashley Ernst, FNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 1041 E Sullivan St, Kingsport, TN 37660 Phone: 423-279-2777
Kelly A Cox, NP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 2050 Meadowview Pkwy, Kingsport, TN 37660 Phone: 423-230-5000 Fax: 423-230-5613
Sherry Lynn Goode, NP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 130 W Ravine Rd, Kingsport, TN 37660 Phone: 423-224-3628 Fax: 423-224-3629
Amanda M Malone, MSN, FNP-BC Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 101 Professional Park Pvt Dr, Kingsport, TN 37663 Phone: 423-239-7300
Mrs. Amanda Susan Burns, ARNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 111 W Stone Dr Ste 110, Kingsport, TN 37660 Phone: --
Mary Renee Mcnees, FNP-BC Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 2300 Pavilion Drive, Kingsport, TN 37660 Phone: 423-765-9655 Fax: 423-979-6333

Jackie A Church, APN - Medicare Nurse Practitioner in Kingsport, TN