MEDICARE: MIKAYLA B DUNCAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	34160	TN
2	363LF0000X	Family Nurse Practitioner	0024190046	VA

General Provider Information

NPI Number	:	1053092122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIKAYLA B DUNCAN

Provider Business Mailing Address
First Line	:	1021 W OAKLAND AVE STE 310
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-2192
Country	:	US
Telephone Number	:	423-952-2111
Fax Number	:

Provider Business Practice Location Address
First Line	:	271 MEDICAL PARK BLVD
Second Line	:
City	:	BRISTOL
State	:	TN
Zip	:	37620-7455
Country	:	US
Telephone Number	:	423-274-8600
Fax Number	:	423-390-6845

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2023
Last Update Date	:	02/11/2026

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Directions to “ MIKAYLA B DUNCAN ” Practice Location

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