Jacqueline Kathy Tellez, is a medicare enrolled "Nurse Practitioner - Family" in Watauga, Tennessee. Her current practice location is
1834 Bristol Hwy, Watauga, Tennessee. You can reach out to her office (for appointments etc.) via phone at
(423) 833-6539.
Jacqueline Kathy Tellez is licensed to practice in Tennessee (license number 0000031726) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1790408961.
Provider's Profile
| Full Name | Jacqueline Kathy Tellez |
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| Gender | Female |
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| Speciality | Nurse Practitioner - Family |
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| Location | 1834 Bristol Hwy, Watauga, Tennessee |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1790408961
- Provider Enumeration Date: 09/22/2022
- Last Update Date: 09/22/2022
Medicare PECOS Information:
- PECOS PAC ID: 3173993151
- Enrollment ID: I20230109001750
Medical Identifiers
Medical identifiers for Jacqueline Kathy Tellez such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1790408961 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 363LF0000X | Nurse Practitioner - Family | 0000031726 (Tennessee) | Primary |
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. Jacqueline Kathy Tellez allows following entities to bill medicare on her behalf.
| Entity Name | Southeastern Physician Services Pc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1083835441
PECOS PAC ID: 0042307852
Enrollment ID: O20071025000571 |
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| Entity Name | Fast Pace Medical Clinic Pllc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1134452865
PECOS PAC ID: 5395881841
Enrollment ID: O20091014000112 |
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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. Jacqueline Kathy Tellez 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 |
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Jacqueline Kathy Tellez,
1834 Bristol Hwy,
Watauga, TN 37694-3198
Ph: () - | Jacqueline Kathy Tellez,
1834 Bristol Hwy,
Watauga, TN 37694-3198
Ph: (423) 833-6539 |
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