| Boones Creek Medical Pllc | |
|
2685 Boones Creek Road Suite 104 Johnson City TN 37615 | |
| (423) 282-0636 | |
| (423) 282-1990 |
| Full Name | Boones Creek Medical Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 2685 Boones Creek Road, Johnson City, Tennessee |
| Authorized Official Name and Position | Amber F Wilkinson (OWNER/ADMINISTRATOR) |
| Authorized Official Contact | 4232820636 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Boones Creek Medical Pllc 1000 W Jackson Blvd Ste 5 Jonesborough TN 37659-5397 Ph: (423) 282-1990 | Boones Creek Medical Pllc 2685 Boones Creek Road Suite 104 Johnson City TN 37615 Ph: (423) 282-0636 |
| NPI Number | 1871528976 |
|---|---|
| Provider Enumeration Date | 07/11/2006 |
| Last Update Date | 02/13/2020 |
| Medicare PECOS PAC ID | 6507969631 |
|---|---|
| Medicare Enrollment ID | O20070310000108 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871528976 | NPI | - | NPPES |
| 3735590 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Mark J Wilkinson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1588619738 PECOS PAC ID: 7416050547 Enrollment ID: I20070310000111 |
| Provider Name | Amber F Wilkinson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053535211 PECOS PAC ID: 7214037902 Enrollment ID: I20070710000963 |
| Provider Name | Elizabeth A Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962524017 PECOS PAC ID: 8628160652 Enrollment ID: I20070822001305 |
| Provider Name | Doris A Casey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285869628 PECOS PAC ID: 7618029125 Enrollment ID: I20090714000737 |
| Provider Name | Michael J May |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134585326 PECOS PAC ID: 4284931312 Enrollment ID: I20160404002212 |
| Provider Name | Marissa Kirchenbauer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851890693 PECOS PAC ID: 2264793959 Enrollment ID: I20220909002511 |
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