EAST TENNESSEE STATE UNIVERSITY NPI 1275902884

NPI Information

EAST TENNESSEE STATE UNIVERSITY is a family nurse practitioner in Johnson City, TN. EAST TENNESSEE STATE UNIVERSITY NPI is 1275902884. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Northside Elementary School Clinic.

The provider's business location address is:

1000 N ROAN ST
JOHNSON CITY, TN
ZIP 37601-616
Phone: (423) 434-5249
Fax: (423) 434-5295

The provider's authorized official is Betty J King .
The authorized official title is Acting Chief Financial Officer and has the following contact phone number (423) 439-4414.

The CLIA number assigned to this NPI record is 44D2171832 - school/student health service with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/24/2015 and was last updated on 2/23/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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