Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.
DEBORAH J HASSEBROCK FNP
Complete NPI Record 1578819439
Nurse Practitioner - Family in Mountain City, TN
Active since July 30, 2012PECOS Enrolled
Complete NPI Dataset
This page contains the complete raw NPPES record for Deborah J Hassebrock, FNP (NPI 1578819439), an individual nurse practitioner provider in Mountain City, TN. All 43 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.
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Registry File Document Utilities
- NPI: 1578819439 Field 1/43
- The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
- Entity Type Code: 1 Field 2/43
- Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
- Provider Last Name Legal Name: HASSEBROCK Field 3/43
- The last name of the provider. If the provider is an individual, this is the legal name.
- Provider First Name: DEBORAH Field 4/43
- The first name of the provider, if the provider is an individual.
- Provider Middle Name: J Field 5/43
- The middle name of the provider, if the provider is an individual.
- Provider Credential Text: FNP Field 6/43
- The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
- Provider First Line Business Mailing Address: 1021 W OAKLAND AVE STE 310 Field 7/43
- The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
- Provider Business Mailing Address City Name: JOHNSON CITY Field 8/43
- The city name in the mailing address of the provider being identified.
- Provider Business Mailing Address State Name: TN Field 9/43
- The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
- Provider Business Mailing Address Postal Code: 376042192 Field 10/43
- The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
- Provider Business Mailing Address Country Code If outside U S : US Field 11/43
- The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
- Provider Business Mailing Address Telephone Number: 4239522111 Field 12/43
- The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
- Provider First Line Business Practice Location Address: 1901 S SHADY STREET Field 13/43
- The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
- Provider Business Practice Location Address City Name: MOUNTAIN CITY Field 14/43
- The city name in the location address of the provider being identified.
- Provider Business Practice Location Address State Name: TN Field 15/43
- The State code in the location of the provider being identified.
- Provider Business Practice Location Address Postal Code: 376832021 Field 16/43
- The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
- Provider Business Practice Location Address Country Code If outside U S : US Field 17/43
- The country code in the location address of the provider being identified.
- Provider Business Practice Location Address Telephone Number: 4237271150 Field 18/43
- The telephone number associated with the location address of the provider being identified.
- Provider Business Practice Location Address Fax Number: 4237271152 Field 19/43
- The fax number associated with the location address of the provider being identified.
- Provider Gender Code: F Field 22/43
- The code designating the provider's gender if the provider is a person.
- Healthcare Provider Taxonomy Code 1: 363LF0000X Field 23/43
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Provider License Number 1: 0024170118 Field 24/43
- The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with "provider taxonomy code".
- Provider License Number State Code 1: VA Field 25/43
- The two-letter state code representing the U.S. state or territory that issued the provider's license. This field is linked to the Provider License Number field and identifies the jurisdiction where that license is valid. A provider may have multiple state codes if they hold licenses in more than one state.
- Healthcare Provider Primary Taxonomy Switch 1: N Field 26/43
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 2: 363LF0000X Field 27/43
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Provider License Number 2: 16767 Field 28/43
- The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with "provider taxonomy code".
- Provider License Number State Code 2: TN Field 29/43
- The two-letter state code representing the U.S. state or territory that issued the provider's license. This field is linked to the Provider License Number field and identifies the jurisdiction where that license is valid. A provider may have multiple state codes if they hold licenses in more than one state.
- Healthcare Provider Primary Taxonomy Switch 2: Y Field 30/43
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Other Provider Identifier 1: 1529530 Field 31/43
- An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
- Other Provider Identifier Type Code 1: 05 Field 32/43
- A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
- Other Provider Identifier State 1: TN Field 33/43
- The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
- Other Provider Identifier 2: 16767 Field 34/43
- An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
- Other Provider Identifier Type Code 2: 01 Field 35/43
- A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
- Other Provider Identifier State 2: TN Field 36/43
- The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
- Other Provider Identifier Issuer 2: ST LIC Field 37/43
- The name of the organization, agency, or health plan that assigned the additional provider identifier. This identifies who issued the number linked to Other Provider Identifier 1 (for example, a state Medicaid agency, Medicare, or a private insurance company).
- Other Provider Identifier 3: 1206755 Field 38/43
- An additional identifier number for the provider, either current or previously used. This may include IDs issued by health plans, state agencies, or other organizations. The value is collected from the NPI application or update form.
- Other Provider Identifier Type Code 3: 01 Field 39/43
- A code that specifies the type of additional identifier associated with the provider, either current or past. Examples include UPIN (Universal Provider Identification Number), NSC (National Supplier Clearinghouse), OSCAR (CMS Certification Number), DEA (Drug Enforcement Administration number), state Medicaid ID, or a plan-specific PIN. The value is collected from the NPI application or update form.
- Other Provider Identifier State 3: TN Field 40/43
- The two-letter state code representing the U.S. state or territory that issued the additional provider identifier. This links the Other Provider Identifier to the state where it is valid or was assigned.
- Other Provider Identifier Issuer 3: ST LIC Field 41/43
- The name of the organization, agency, or health plan that assigned the additional provider identifier. This identifies who issued the number linked to Other Provider Identifier 1 (for example, a state Medicaid agency, Medicare, or a private insurance company).
- Is Sole Proprietor: N Field 42/43
- Indicates whether the provider is registered as a sole proprietor. This is a single-character code: "Y" means the provider operates as a sole proprietor, and "N" means they do not.
Secondary Practice Locations 21
The first line of the secondary practice location address of the provider being identified. For providers with more than one physical location, this is a secondary practice location address. This address cannot include a Post Office box.
364 Hospital Dr
Location 1/21Clintwood, VA 24228-6786 · Phone (276) 926-0200
2205 Pavilion Dr Ste 101
Location 2/21Kingsport, TN 37660-4641 · Phone (423) 392-6000
403 Princeton Rd Ste 10
Location 3/21Johnson City, TN 37601-2062 · Phone (423) 431-7340
127 Health Care Dr Ste 8
Location 4/21Pennington Gap, VA 24277-2853 · Phone (276) 546-5212
1497 W Elk Ave Ste 21
Location 5/21Elizabethton, TN 37643-2896 · Phone (423) 542-7420
12180 Alder St
Location 6/21Meadowview, VA 24361-3938 · Phone (276) 695-0205
515 Front St W
Location 7/21Coeburn, VA 24230-3607 · Phone (276) 395-2389
1490 Park Ave NW Ste 3
Location 8/21Norton, VA 24273-1631 · Phone (276) 679-8890
115 Judge Gresham Rd Ste B
Location 9/21Gray, TN 37615-6213 · Phone (423) 477-2010
323 Cloverleaf Sq # 1
Location 10/21Big Stone Gap, VA 24219-2760 · Phone (276) 523-6715
350 Blountville Hwy Ste 106
Location 11/21Bristol, TN 37620-1671 · Phone (423) 968-2446
308 8th St Ste A
Location 12/21Bristol, TN 37620-2228 · Phone (423) 844-6860
250 Stage Coach Rd
Location 13/21Bristol, VA 24201-8304 · Phone (276) 466-0584
2204 Pavilion Dr Ste 200
Location 14/21Kingsport, TN 37660-4652 · Phone (423) 224-3900
111 W Stone Dr Ste 200
Location 15/21Kingsport, TN 37660-6028 · Phone (423) 723-2030
603 Campus Dr Ste 100
Location 16/21Abingdon, VA 24210-9700 · Phone (276) 628-4406
636 S Monte Vista Dr
Location 17/21Glade Spring, VA 24340-2712 · Phone (276) 429-5163
701 Med Tech Pkwy Ste 401
Location 18/21Johnson City, TN 37604-2372 · Phone (423) 631-0646
2885 Boones Creek Rd Ste 202
Location 19/21Johnson City, TN 37615-8004 · Phone (423) 952-8050
16000 Johnston Memorial Dr Ste 213
Location 20/21Abingdon, VA 24211-0001 · Phone (276) 258-2600
350 Blountville Hwy Ste 205
Location 21/21Bristol, TN 37620-1671 · Phone (423) 968-6650
Other Provider Identifiers 3
Legacy and payer-issued identifiers reported to the NPPES registry for this provider.
1529530 Medicaid
Identifier 1/3State: TN
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.
Medicaid (State-specific): A provider identification number assigned by an individual state's Medicaid program, used for billing and enrollment within that state's Medicaid system.
16767 Other
Identifier 2/3State: TN · Issuer: St Lic
Other: An additional provider identifier that does not correspond to any of the other defined identifier type categories.
Other: An additional provider identifier that does not correspond to any of the other defined identifier type categories.
1206755 Other
Identifier 3/3State: TN · Issuer: St Lic
Other: An additional provider identifier that does not correspond to any of the other defined identifier type categories.
Other: An additional provider identifier that does not correspond to any of the other defined identifier type categories.
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