JACKIE A CHURCH (APN) – Registered Nurse, NPI 1629126321
Registered Nurse
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
8,307 NURSE PRACTITIONER in VA
Provider Addresses for JACKIE A CHURCH (APN)
344 OVERLOOK DR STE 200
LEBANON, VA 242663436
Phone: (276) 883-5900
Type: Location
130 W Ravine Rd
Kingsport, TN 376603837
Phone: (423) 239-9737
Type: Location
1 Medical Park Blvd Ste 102W
Bristol, TN 376207430
Phone: (423) 844-1121
Type: Location
1500 W Elk Ave
Elizabethton, TN 376432654
Phone: (423) 543-2584
Fax: (423) 722-2060
Type: Location
1420 Tusculum Blvd
Greeneville, TN 377454279
Phone: (423) 787-5000
Type: Location
108 Park Ave
Banner Elk, NC 286046604
Phone: (828) 783-9183
Type: Location
400 N State Of Franklin Rd
Johnson City, TN 376046035
Phone: (423) 431-6111
Type: Location
2030 Temple Hill Rd
Erwin, TN 376508721
Phone: (423) 735-4700
Type: Location
111 W Stone Dr Ste 110
Kingsport, TN 376606027
Phone: (423) 224-3701
Type: Location
2000 Brookside Dr
Kingsport, TN 376604627
Phone: (423) 857-7000
Type: Location
4600 Fort Henry Dr
Kingsport, TN 376632617
Phone: (423) 224-3950
Type: Location
Medical Care, 1500, West Elk Avenue, Riovista, Elizabethton, Carter County, Tennessee, 37643, United States
ELIZABETHTON, TN 376432654
Phone: (423) 543-2584
Fax: (423) 722-2060
Type: Mailing
1021 W OAKLAND AVE STE 310
JOHNSON CITY, TN 376042192
Phone: (423) 952-2111
Fax: (423) 282-1657
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $150.
Total Amount is formed as General ($150) + Research ($0) + Ownership ($0) = $150.
Last reported payment date: 2023-07-24 • Largest payer in this snapshot: Actelion Pharmaceuticals US, Inc. ($150).
Total Amount
$150
General + Research + Ownership
Payments
1
Total payment records
General Amount
$150
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-07-24
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Actelion Pharmaceuticals US, Inc. | $150 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2023-10-10
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20070615000550 | I | Nurse Practitioner | TN | TBD |
| I20231010003012 | I | Nurse Practitioner | NC | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 24266)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | TN | |
| - | TN | |
| General Surgery | MD | |
| O T O L A R Y N G O L O G Y | TN | |
| Hematology/Oncology, Hospitalist | FL | |
| G A S T R O E N T E R O L O G Y | TN | |
| N E U R O S U R G E R Y | IL | |
| - | TN | |
| Nurse Practitioner | TN | |
| Physician Assistant | TN |
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