Search › Tennessee › 207R00000X
Nerissa Licup, MD
NPI 1720269731 · on the registry since 2007
Practice
- Address
- 2205 Pavilion Dr Ste 101
Kingsport, TN 37660 - Phone
- (423) 392-6000
- Fax
- (423) 392-6030
- Organisation at this address
- Blue Ridge Medical Management Corporation
Blue Ridge Medical Management Corporation
Blue Ridge Medical Management Corporation
Blue Ridge Medical Management Corporation
Blue Ridge Medical Management CorporationInferred from a shared address, not stated in the registry. - Clinicians at this address
- 18
Additional practice sites
- 1 Medical Park Blvd Ste 200e, Bristol, TN
- 111 W Stone Dr Ste 200, Kingsport, TN
- 115 Judge Gresham Rd Ste A, Gray, TN
Registry record
- Primary taxonomy
- 207R00000X
207R00000X
- Also registered as
- 390200000X
- Licence states on file
- TN
From the registry's licence fields, which are often incomplete.
- Sex
- Female
- Record last updated
- 2024-06-10
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Tennessee