EAST TENNESSEE STATE UNIVERSITY (NPI# 1124593132) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124593132 |
| Entity Type | Organization |
| Organization Name | EAST TENNESSEE STATE UNIVERSITY |
| Other Organization Name | COLLEGE OF NURSING CLINICS |
| Practice Address |
2151 Century Ln Johnson City TN 37604-4469 |
| Mailing Address |
365 Stout Drive, Box 70403 Johnson City TN 37614 |
| Practice Telephone | 4239262500 |
| Practice Fax Number | 4239265999 |
| Mailing Telephone | 4234336141 |
| Mailing Fax Number | 4234336062 |
| Enumeration Date | 2018-10-05 |
| Last Update Date | 2018-10-15 |
| Authorized Official Name | BETTY J. KING (CHIEF FINANCIAL OFFICER) |
| Authorized Official Telephone | 4234394414 |
| Is Organization Subpart | Y |
| Parent Organization Name | EAST TENNESSEE STATE UNIVERSITY |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1041C0700X |
Social Worker Specialization: Clinical |
Behavioral Health & Social Service Providers | ||
| N | 122300000X | Dentist | Dental Providers | ||
| N | 225100000X | Physical Therapist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| N | 235Z00000X | Speech-Language Pathologist | Speech, Language and Hearing Service Providers | ||
| N | 363LP0200X |
Nurse Practitioner Specialization: Pediatrics |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363LW0102X |
Nurse Practitioner Specialization: Women's Health |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 367A00000X | Advanced Practice Midwife | Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
Physician Assistants & Advanced Practice Nursing Providers |
| Other Name | Type Code |
|---|---|
| College of Nursing Clinics | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 391 Court Sq, Sneedville, TN 37869 | 4237332121 | 4237334563 |
| 202 W Fairview Ave, Johnson City, TN 376045611 | 4234397371 | 4234397383 |
| 1901 S Shady St, Mountain City, TN 376832021 | 4237271150 | 4237271151 |
| 2700 Main St, Sneedville, TN 378693041 | 4237332819 | 4237338509 |
| 365 Stout Drive, Suite 160, Johnson City, TN 37614 | 4234394225 | 4234394560 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275902884 | East Tennessee State University | Nurse Practitioner | 1000 N Roan St, Johnson City, TN 37601-4616 | 2015-09-24 |
| 1952785081 | East Tennessee State University | Nurse Practitioner | 3261 Tn 81, Jonesborough, TN 37659 | 2015-07-18 |
| 1982905576 | East Tennessee State University | Clinic/Center | 1134-1136 E. Main Street, Johnson City, TN 37601 | 2010-11-12 |
| 1851526826 | East Tennessee State University | Nurse Practitioner | 306 Forrest Dr, Jonesborough, TN 37659-1550 | 2009-05-20 |
| 1548422330 | East Tennessee State University | Audiologist | 837 Pardee St, Johnson City, TN 37601-5900 | 2008-07-02 |
| 1942474762 | East Tennessee State University | Speech-Language Pathologist | 300 Urbana Rd, Limestone, TN 37681-2824 | 2008-04-14 |
| 1093990608 | East Tennessee State University | Clinic/Center | 202 W Fairview Ave, Johnson City, TN 37604-5611 | 2008-01-02 |
| 1326142563 | East Tennessee State University | Nurse Practitioner | 391 Court Sq, Sneedville, TN 37869-0723 | 2006-09-08 |
| 1568570273 | East Tennessee State University | Nurse Practitioner | 365 Stout Drive, Nicks Hall Rm 160, Johnson City, TN 37614-6500 | 2006-08-25 |
| 1215045976 | East Tennessee State University | Nurse Practitioner | 2700 Main Street, Sneedville, TN 37869-0723 | 2006-08-25 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | EAST TENNESSEE STATE UNIVERSITY | 2109 W Market St, Johnson City, TN 37604-6024 |
| Street Address |
2151 CENTURY LN |
| City | JOHNSON CITY |
| State | TN |
| Zip Code | 37604-4469 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245238914 | Rebecca A Morrison | Nurse Practitioner | 2151 Century Ln, Johnson City, TN 37604-4469 | 2005-07-07 |
| 1275169187 | Sudha Raj Kumar | Nurse Practitioner | 2151 Century Ln, Johnson City, TN 37604-4469 | 2020-03-23 |
| 1710522636 | Natalie Grace Wigle | Social Worker | 2151 Century Ln, Johnson City, TN 37604-4469 | 2019-11-14 |
| 1093281297 | Ernest David Maupin | Nurse Practitioner | 2151 Century Ln, Johnson City, TN 37604-4469 | 2018-10-16 |
| 1760923536 | Tonja Schnelle | Nurse Practitioner | 2151 Century Ln, Johnson City, TN 37604-4469 | 2017-03-14 |
| 1477009215 | Amanda York | Social Worker | 2151 Century Ln, Johnson City, TN 37604-4469 | 2016-08-31 |
| 1770933186 | Sarah S Carlisle | Dentist | 2151 Century Ln, Johnson City, TN 37604-4469 | 2016-06-16 |
| 1154780716 | East Tennessee State University | Pharmacy | 2151 Century Ln, Johnson City, TN 37604-4469 | 2016-02-11 |
| 1831554575 | Paige R Mullins | Nurse Practitioner | 2151 Century Ln, Johnson City, TN 37604-4469 | 2015-12-23 |
| 1477959609 | Kyli Riehl Whitehead | Nurse Practitioner | 2151 Century Ln, Johnson City, TN 37604-4469 | 2014-11-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417560707 | Brant Logan Nickens | Physical Therapist | 809 Lamont St and Veterans Way, Johnson City, TN 37604 | 2020-08-26 |
| 1952911562 | David Sandlin Hobbs | Pharmacist | Lamont St &, Veterans Way, Johnson City, Tn 37604, Johnson City, TN 37604 | 2020-08-07 |
| 1528688272 | Whitney Marie Ward | Physical Therapist | Lamont Street and Veterans Way, Johnson City, TN 37604 | 2020-04-23 |
| 1861050015 | Akesh Thomas | Student in an Organized Health Care Education/Training Program | Johnson City Medical Center, 400 N State of Franklin Rd, Johnson City, TN 37604 | 2019-06-03 |
| 1336629021 | Medical Education Assistance Corporation | Clinic/Center | 820 W Market St, Johnson City, TN 37604 | 2018-08-21 |
| 1093208951 | Lauren Tiffany Hayden | Physician Assistant | 403 N State of Franklin Rd Woodridge Hospital, Johnson City, TN 37604 | 2018-06-14 |
| 1174014450 | Jerica Moore | Specialist/Technologist | 1041 Hamiltion Place Dr., Johnson City, TN 37604 | 2018-05-23 |
| 1053809442 | Syed Ghazanfar Hasan | Student in an Organized Health Care Education/Training Program | Etsu Psychiatry and Behavioral Sciences Department, 1276 Gilbreath Dr., Johnson City, TN 37604 | 2018-05-01 |
| 1699262485 | Sonia Kumari Oad | Student in an Organized Health Care Education/Training Program | 178 West Maple St, Johnson City, TN 37604 | 2018-04-17 |
| 1821519364 | Mahmoud El Iskandarani | Internal Medicine | 1084 W Oakland Avenue, 748, Johnson City, TN 37604 | 2017-07-06 |
| Find all providers in zip 37604 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063025724 | Victoria Elizabeth Mcmanus | Nurse Practitioner | 365 Harry L Dr Ste 110, Johnson City, NY 13790-1471 | 2020-08-24 |
| 1649880139 | Amanda Danielle Ledford | Nurse Practitioner | 3 Enfield Ct, Johnson City, TN 37604-9101 | 2020-08-09 |
| 1861000135 | Deborah L Johnson | Nurse Practitioner | 2 Mcgregor Pl, Johnson City, TN 37604-1454 | 2020-07-22 |
| 1255978417 | William Mcguire | Nurse Practitioner | 176 Willocks Rd, Johnson City, TN 37601-6274 | 2019-12-06 |
| 1881248664 | Caiti Riden | Nurse Practitioner | 316 Marketplace Dr Ste 10, Johnson City, TN 37604-2595 | 2019-07-30 |
| 1699330282 | Courtney S Willis | Nurse Practitioner | 2203 N Greenwood Dr, Johnson City, TN 37604-7030 | 2019-05-08 |
| 1861955452 | Cindy Canter | Nurse Practitioner | 3552 Greenwood Dr, Johnson City, TN 37604-2834 | 2019-04-10 |
| 1366908980 | Holly Anne Parvin | Nurse Practitioner | 3209 W Walnut St, Johnson City, TN 37604-5949 | 2019-02-19 |
| 1891261376 | Lindsey Toney | Nurse Practitioner | 980 Smalling Rd, Johnson City, TN 37601-8208 | 2018-10-22 |
| 1821572868 | Karyn Kimberly Bruton | Nurse Practitioner | 1723 N Roan St, Johnson City, TN 37601-3949 | 2018-09-15 |
| Find all providers in JOHNSON CITY | ||||
| City | JOHNSON CITY |
| Zip Code | 37604 |
Please comment or provide details below to improve the information on EAST TENNESSEE STATE UNIVERSITY.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.