Organization
EAST TENNESSEE STATE UNIVERSITY
Active
Parent organization
EAST TENNESSEE STATE UNIVERSITY
Other names
College of Nursing Clinics
Organization subpart
Yes
Provider details
NPI number
Legal business name
EAST TENNESSEE STATE UNIVERSITY
Authorized official
BETTY J. KING (CHIEF FINANCIAL OFFICER)
(423) 439-4414
Entity
Organization
Contact information
Practice address
2151 CENTURY LN, JOHNSON CITY, TN 37604-4469
(423) 926-2500
(423) 926-5999
Mailing address
365 STOUT DRIVE, BOX 70403, JOHNSON CITY, TN 37614
(423) 433-6141
(423) 433-6062
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
122300000X
Dentist
—
—
225100000X
Physical Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
363LF0000X
Family Nurse Practitioner
Primary
—
—
363LP0200X
Pediatric Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
363LW0102X
Women's Health Nurse Practitioner
—
—
367A00000X
Advanced Practice Midwife
—
—
Other
Enumeration date
10/05/2018
Last updated
10/15/2018
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