NPIMap

Organization Active NPI

East Tennessee State University

Doing business as College of Nursing Clinics

  • Family Nurse Practitioner
  • Johnson City, TN
National Provider Identifier
1124593132
Registry record updated Oct 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
EAST TENNESSEE STATE UNIVERSITY
Doing business as
College of Nursing Clinics
Practice address
2151 Century LN
Johnson City, TN 37604-4469
Phone
(423) 926-2500
Fax
(423) 926-5999
NPI assigned
Oct 5, 2018
Last updated
Oct 15, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
EAST TENNESSEE STATE UNIVERSITYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 15, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Betty J. King
Title
Chief Financial Officer
Phone
(423) 439-4414

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X NU Primary
Pediatric Nurse Practitioner 363LP0200X NU
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NU
Women's Health Nurse Practitioner 363LW0102X NU
Advanced Practice Midwife 367A00000X NU
Clinical Social Worker 1041C0700X NU
Dentist 122300000X NU
Physical Therapist 225100000X NU
Speech-Language Pathologist 235Z00000X NU

Addresses

Primary practice location

2151 Century LN
Johnson City, TN 37604-4469

Mailing address

365 Stout Drive, Box 70403
Johnson City, TN 37614
Phone (423) 433-6141

Other practice location 1

1901 S Shady St
Mountain City, TN 37683-2021
Phone (423) 727-1150

Other practice location 2

391 Court Sq
Sneedville, TN 37869
Phone (423) 733-2121

Other practice location 3

2700 Main St
Sneedville, TN 37869-3041
Phone (423) 733-2819

Other practice location 4

365 Stout Drive
Suite 160
Johnson City, TN 37614
Phone (423) 439-4225

Other practice location 5

202 W Fairview Ave
Johnson City, TN 37604-5611
Phone (423) 439-7371

Other names 1

  • College of Nursing Clinics Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Etsu Behavioral Health and Wellness Clinic20 organizations share this tax ID, including this one
Part of
Etsu Behavioral Health and Wellness Clinic

Other organizations with this tax ID 19

Organizations that report the same tax identification number in the National Provider Directory.

View all 19

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1538697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1539561600000",
    "number": "1124593132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "365 STOUT DRIVE, BOX 70403",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "37614",
            "telephone_number": "423-433-6141",
            "fax_number": "423-433-6062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2151 CENTURY LN",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376044469",
            "telephone_number": "423-926-2500",
            "fax_number": "423-926-5999"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1901 S Shady St",
            "address_purpose": "LOCATION",
            "city": "Mountain City",
            "state": "TN",
            "postal_code": "376832021",
            "country_code": "US",
            "telephone_number": "423-727-1150",
            "fax_number": "423-727-1151",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "391 Court Sq",
            "address_purpose": "LOCATION",
            "city": "Sneedville",
            "state": "TN",
            "postal_code": "37869",
            "country_code": "US",
            "telephone_number": "423-733-2121",
            "fax_number": "423-733-4563",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2700 Main St",
            "address_purpose": "LOCATION",
            "city": "Sneedville",
            "state": "TN",
            "postal_code": "378693041",
            "country_code": "US",
            "telephone_number": "423-733-2819",
            "fax_number": "423-733-8509",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "365 Stout Drive",
            "address_2": "Suite 160",
            "address_purpose": "LOCATION",
            "city": "Johnson City",
            "state": "TN",
            "postal_code": "37614",
            "country_code": "US",
            "telephone_number": "423-439-4225",
            "fax_number": "423-439-4560",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "202 W Fairview Ave",
            "address_purpose": "LOCATION",
            "city": "Johnson City",
            "state": "TN",
            "postal_code": "376045611",
            "country_code": "US",
            "telephone_number": "423-439-7371",
            "fax_number": "423-439-7383",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EAST TENNESSEE STATE UNIVERSITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EAST TENNESSEE STATE UNIVERSITY",
        "enumeration_date": "2018-10-05",
        "last_updated": "2018-10-15",
        "status": "A",
        "authorized_official_last_name": "KING",
        "authorized_official_first_name": "BETTY",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "423-439-4414"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "College of Nursing Clinics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Johnson City, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.