East Tennessee State University
Organization Active NPI Primary Care Nurse Practitioner · Jonesborough, TN
NPI 1508091562 · NPPES record last updated Feb 23, 2017
Key facts
- NPI
- 1508091562
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Primary Care Nurse Practitioner 363LP2300X
- Legal business name
- EAST TENNESSEE STATE UNIVERSITY
- Practice address
- 684 Old State Route 34
Jonesborough, TN 37659-6094 - Phone
- (423) 753-0057
- Fax
- (423) 753-1167
- NPI assigned
- May 20, 2009
- Organization subpart
- No
Authorized official
- Name
- Ms. Betty J. King
- Title
- Acting Chief Financial Officer
- Phone
- (423) 439-4414
Corporate family (same tax ID) 19
Practitioners 2
-
Jennie L. Walls, FNP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 44D2171891 | David Crockett High School | Certificate of waiver | Sep 9, 2027 |
National Provider Directory
- Tax ID family
- East Tennessee State University
Locations
684 Old State Route 34
Jonesborough, TN 37659
Phone (423) 753-0057
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Nurse Practitioner |
363LP2300X | Yes |
Addresses
Primary practice location
684 Old State Route 34
Jonesborough, TN 37659-6094
Mailing address
365 Stout Drive Box 70403
Johnson City, TN 37614-1703
Phone (423) 439-4071
Other names
- David Crockett High School Based Health Clinic
Other providers in Jonesborough, TN
- Deborah Defrieze
- Courtney Dennis
- Lara Denton Ayres
- Dr Benjamin D. Parrish and Associates OD PC
- Rachel A Draper
- East Tennessee State University
- East Tennessee State University
- Linda M Elswick
- Sydney Emore
- Enclavejoy LLC
All providers in Jonesborough, TN · Primary Care Nurse Practitioner in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 23, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.