Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Bobby Ray Nichols III, FNP-C

Individual provider Nurse Practitioner · NPI 1205468923

Bobby Ray Nichols III, FNP-C is a Nurse Practitioner in Kingsport, Tennessee. Graduated from Lincoln Memorial University Medical Department in 2019, 7 years ago. Practices with Blue Ridge Medical Management Corporation, a 286-clinician group and accepts Medicare assignment. Licensed in Tennessee.

Years since qualifying
7
Trained at
Lincoln Memorial University Medical Department
Licensed in
TN
In the registry since
2020
What do these letters mean?
FNP-C — Family Nurse Practitioner, Certified
A family nurse practitioner certified by the AANP.

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Practice location Address checks out

2204 Pavilion Dr Ste 200
Kingsport, TN 37660-4652
Phone: (423) 224-3900
Fax: (423) 224-3901
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence 26999 (TN)

Record details

NPI number1205468923
Entity typeIndividual (Type 1)
GenderMale
Credentials FNP-C
Sole proprietorNo
NPI enumeratedFebruary 11, 2020
Last updated in NPPESNovember 26, 2024
Certification dateNovember 26, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolLINCOLN MEMORIAL UNIVERSITY MEDICAL DEPARTMENT
Graduated 2019 (7 years in practice)
Group practice Blue Ridge Medical Management Corporation — 286 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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