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Dr. Nerissa Licup, MD
Internal Medicine Physician in Kingsport, Tennessee
NPI 1720269731

Nerissa Licup is a Internal Medicine Physician based in Johnson City, TN. Nerissa Licup practices in Kingsport, TN and has the professional credentials of MD. The NPI Number for Nerissa Licup is 1720269731 and holds a License No. (Tennessee).

The current practice location address for Nerissa Licup is 2205 Pavilion Dr Ste 101, Kingsport, TN and can be reached out via phone at 423-392-6000 and via fax at 423-392-6030.

Location: 2205 Pavilion Dr Ste 101, Kingsport, TN, 37604-2192
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1720269731
Provider Name
Nerissa Licup
Credential
MD
Provider Entity Type
Individual
Gender
Female
Address
2205 Pavilion Dr Ste 101, Kingsport, TN, 37604-2192
Phone Number
423-392-6000
Fax Number
423-392-6030
Provider Enumeration Date
11/19/2007
Last Update Date
07/20/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
4276956 01 TN BLUECARE
1521020 05 TN
P01015971 01 TN RR MEDICARE
1720269731 05 VA
institution
Provider Business Practice Location Address Details
Address
2205 Pavilion Dr Ste 101
City
Kingsport
State
Tennessee
Zip
37660-4641
Phone Number
423-392-6000
Fax Number
423-392-6030
person
Provider Business Mailing Address Details
Address
2205 Pavilion Dr Ste 101
City
Kingsport
State
Tennessee
Zip
37660-4641
Phone Number
423-392-6000
Fax Number
423-392-6030
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
Internal Medicine
Speciality
-
Taxonomy
207R00000X
License No.
46416 (Tennessee)
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
person
Provider's Taxonomy Details 2
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
390200000X
License No.
()
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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