Organization
EAST TENNESSEE STATE UNIVERSITY
Active
Other names
Northside Elementary School Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BETTY J KING (ACTING CHIEF FINANCIAL OFFICER)
(423) 439-4414
Entity
Organization
Contact information
Practice address
1000 N ROAN ST, JOHNSON CITY, TN 37601-4616
(423) 434-5249
(423) 434-5295
Mailing address
365 STOUT DRIVE BOX 70403, JOHNSON CITY, TN 37614-1703
(423) 439-4515
(423) 439-5780
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
09/24/2015
Last updated
02/23/2017
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