Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

DR. ELEISHA JEAN NICKOLES D.D.S
NPI 1053400309
Dentist in Jefferson City, TN

Q: What is Eleisha Nickoles's NPI number?

The NPI number for Eleisha Nickoles is 1053400309. It was assigned to this individual provider in the NPPES registry on October 12, 2006.

Q: What is Eleisha Nickoles's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

Q: When was this NPI record last updated?

The NPPES record for Eleisha Nickoles was last updated on August 19, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 20 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since October 12, 2006PECOS Enrolled

1413 RUSSELL AVE, JEFFERSON CITY, TN 37760(865) 471-5525(865) 471-5526 Get Directions Write a Review

NPPES record last updated: August 19, 2026. Verified against the NPPES registry weekly; last sync: September 06, 2026.

Record update history: Aug 19, 2026, Jan 6, 2022 (2 updates tracked since 2022).

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About Dr. Eleisha Jean Nickoles D.d.s NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. ELEISHA JEAN NICKOLES D.D.S (NPI 1053400309) is an individual dentist in Jefferson City, Tennessee, licensed in Tennessee (12971) and active in the NPI registry since October 2006. She is enrolled in Medicare PECOS and is a graduate of Other (2025).

NPPES Registry Identity

NPI1053400309

Entity TypeIndividualFemale

Primary Taxonomy122300000X

Provider Legal NameDR. ELEISHA JEAN NICKOLESCredential: D.D.S

Location Address1413 RUSSELL AVEJefferson City, TN 37760-2562

Mailing Address370 Leeper OverlookDandridge, TN 37725-5073 · (865) 471-5525 · Fax (865) 471-5526

Phone(865) 471-5525

Fax(865) 471-5526

Sole ProprietorNo

Medical School CMSOtherGraduated 2025

Enumeration DateOctober 12, 2006

Last NPPES UpdateAugust 19, 20262 updates tracked since enumeration

NPPES CertifiedAugust 19, 2026

✔ NPI 1053400309 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentistDental Providers

Taxonomy Code122300000X

License✔ Licensed in TN · 12971

Definition

A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.

1413 RUSSELL AVE, Jefferson City, TN 37760

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Eleisha Jean Nickoles D.d.s is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID3476871732

PECOS Enrollment IDI20260603000982

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 37760 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$81.53 typical visit price

range $52.64 – $160.89

Typical copayment $20.38 (range $13.16 – $40.22)

Most-billed visit code 99203

Established Patient

$66.01 typical visit price

range $16.72 – $131.41

Typical copayment $16.50 (range $4.18 – $32.85)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

UNIVERSITY HEALTH SYSTEM, INC

Internal Medicine