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

Dr. Nerissa Licup, MD

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1720269731

Dr. Nerissa Licup, MD is an Internal Medicine in Kingsport, Tennessee. Qualified in 2004, 22 years ago. Practices with Blue Ridge Medical Management Corporation, a 286-clinician group, works from 4 locations, accepts Medicare assignment and offers telehealth. Licensed in Tennessee.

Years since qualifying
22
Licensed in
TN
In the registry since
2007
Specialties on file
2
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

2205 Pavilion Dr Ste 101
Kingsport, TN 37660-4641
Phone: (423) 392-6000
Fax: (423) 392-6030
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (3)

  • 1 Medical Park Blvd Ste 200e, Bristol, TN 37620-7498 — (423) 844-5100
  • 115 Judge Gresham Rd Ste A, Gray, TN 37615-6213 — (423) 467-3000
  • 111 W Stone Dr Ste 200, Kingsport, TN 37660-6028 — (423) 723-2030

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X · Licence 46416 (TN)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1720269731
Entity typeIndividual (Type 1)
GenderFemale
Credentials MD
Sole proprietorNo
NPI enumeratedNovember 19, 2007
Last updated in NPPESJune 10, 2024
Certification dateJune 10, 2024
Mailing address1021 W Oakland Ave Ste 310, Johnson City, TN 37604-2192

Medicare enrollment

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

Medicare specialtyINTERNAL MEDICINE
Medical schoolOTHER
Graduated 2004 (22 years in practice)
Group practice Blue Ridge Medical Management Corporation — 286 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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