JORDAN BACON (NPI# 1982228847) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1982228847 |
| Entity Type | Individual |
| Full Name | JORDAN BACON |
| Credential | PA |
| Practice Address |
130 W Ravine Rd Kingsport TN 37660-3837 |
| Mailing Address |
139 Greenmeadow Ln Jonesborough TN 37659-3815 |
| Practice Telephone | 4232244000 |
| Enumeration Date | 2020-06-05 |
| Last Update Date | 2020-06-05 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
130 W RAVINE RD |
| City | KINGSPORT |
| State | TN |
| Zip Code | 37660-3837 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275536997 | Medical Mall Pharmacy Inc | Pharmacy | 130 W Ravine Rd, Kingsport, TN 37660-3837 | 2005-05-27 |
| 1598364903 | Kevin White | Physician Assistant | 130 W Ravine Rd, Kingsport, TN 37660-3837 | 2020-10-19 |
| 1093328460 | Corbin Noah Turbyfill | Registered Nurse | 130 W Ravine Rd, Kingsport, TN 37660-3837 | 2020-08-26 |
| 1871106153 | Garon Rick Compton | Registered Nurse | 130 W Ravine Rd, Kingsport, TN 37660-3837 | 2020-08-26 |
| 1780297010 | Caleb Rumley | Registered Nurse | 130 W Ravine Rd, Kingsport, TN 37660-3837 | 2020-08-26 |
| 1992314587 | Ryan Earl Farmer | Emergency Medicine | 130 W Ravine Rd, Kingsport, TN 37660-3837 | 2020-07-29 |
| 1043837933 | Verna Theola Barton | Pharmacist | 130 W Ravine Rd, Kingsport, TN 37660-3837 | 2020-06-26 |
| 1962028043 | Kendra Lauren O'quinn | Nurse Practitioner | 130 W Ravine Rd, Kingsport, TN 37660-3837 | 2020-06-24 |
| 1427673672 | Brooke Stayer | Pharmacist | 130 W Ravine Rd, Kingsport, TN 37660-3837 | 2020-06-13 |
| 1851914600 | Amy F Kite | Pathology | 130 W Ravine Rd, Kingsport, TN 37660-3837 | 2020-05-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750909891 | Nancy Gober | Pharmacist | Holston Valley Medical Center Inpatient Pharmacy, 130 W Ravine, Kingsport, TN 37660 | 2020-07-06 |
| 1700437621 | Tammy Denise Leblanc | Technician | 125 Lancer Rd, Kingsport, TN 37660 | 2019-09-23 |
| 1831743392 | Independent Physical Therapy | Occupational Therapist | 1704 E. Stone Dr. Ste 120, Kingsport, TN 37660 | 2019-08-01 |
| 1871095315 | Macie Anderson | Nurse Practitioner | 411 Clay St, Kingsport, TN 37660 | 2018-03-01 |
| 1053813527 | Pulitzer Orthodontics, LLC | Dentist | 1200 Pulitzer Place, Kingsport, TN 37660 | 2018-03-01 |
| 1174038749 | Sbh-kingsport | Psychiatric Hospital | 1025 Executive Park Blvd, Kingsport, TN 37660 | 2017-12-05 |
| 1548771447 | Sara B Ball | Registered Nurse | 111 W Stone Dr Ste 240, Kingsport, TN 37660 | 2017-10-18 |
| 1821525361 | Ashley Brook Weems | Nurse Practitioner | Six Sheridan Square Suite 100, Kingsport, TN 37660 | 2017-05-15 |
| 1639625643 | Stephanie H Garris | Nurse Practitioner | 117 W Sevier Ave Ste 120, Kingsport, TN 37660 | 2016-08-30 |
| 1073965679 | Teresa Anne Starke | Physician Assistant | 8 Sheridan Square, Suite 110, Kingsport, TN 37660 | 2016-07-07 |
| Find all providers in zip 37660 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073965679 | Teresa Anne Starke | Physician Assistant | 8 Sheridan Square, Suite 110, Kingsport, TN 37660 | 2016-07-07 |
| 1386041101 | Dustin L Barrett | Physician Assistant | 2050 Meadowwview Pkwy., Kingsport, TN 37660-7475 | 2014-11-21 |
| 1265603914 | Stephen Timothy Lawson | Physician Assistant | 121 E Ravine Rd Ste 200, Kingsport, TN 37660-3826 | 2008-03-20 |
| 1477751238 | Clay Deneeen Davis | Physician Assistant | 4509 W Stone Dr, Kingsport, TN 37660-1048 | 2007-07-03 |
| 1932310828 | Cumberland Back Pain Clinic | Physician Assistant | 1732 N Eastman Rd, Kingsport, TN 37664-2376 | 2007-05-24 |
| 1568567535 | William Kendall Johnson | Physician Assistant | 3 Sheridan Square, Kingsport, TN 37660 | 2006-09-14 |
| 1306941372 | Clark Rafael Hernandez | Physician Assistant | Three Sheridan Square, Kingsport, TN 37660 | 2006-09-14 |
| 1598364903 | Kevin White | Physician Assistant | 130 W Ravine Rd, Kingsport, TN 37660-3837 | 2020-10-19 |
| 1770195273 | Daulton Horne | Physician Assistant | 105 W Stone Dr Ste 4b, Kingsport, TN 37660-3365 | 2020-08-18 |
| 1245855501 | Carley Neil Carter | Physician Assistant | 105 W Stone Dr Ste 4b, Kingsport, TN 37660-3365 | 2020-06-12 |
| Find all providers in KINGSPORT | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.