EAST TENNESSEE STATE UNIVERSITY (NPI# 1275902884) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275902884 |
| Entity Type | Organization |
| Organization Name | EAST TENNESSEE STATE UNIVERSITY |
| Other Organization Name | NORTHSIDE ELEMENTARY SCHOOL CLINIC |
| Practice Address |
1000 N Roan St Johnson City TN 37601-4616 |
| Mailing Address |
365 Stout Drive Box 70403 Johnson City TN 37614-1703 |
| Practice Telephone | 4234345249 |
| Practice Fax Number | 4234345295 |
| Mailing Telephone | 4234394515 |
| Mailing Fax Number | 4234395780 |
| Enumeration Date | 2015-09-24 |
| Last Update Date | 2017-02-23 |
| Authorized Official Name | MS. BETTY J KING (ACTING CHIEF FINANCIAL OFFICER) |
| Authorized Official Telephone | 4234394414 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
Physician Assistants & Advanced Practice Nursing Providers |
| Other Name | Type Code |
|---|---|
| Northside Elementary School Clinic | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 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 |
| 1295779361 | East Tennessee State University | Clinic/Center | 1901 S Shady Street, Mountain City, TN 37683-2601 | 2006-06-16 |
| 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 |
1000 N ROAN ST |
| City | JOHNSON CITY |
| State | TN |
| Zip Code | 37601-4616 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396381992 | Juan Carlos Simon Villegas Gomez | Specialist/Technologist | 1081 John Robert Bell Dr, Johnson City, TN 37601 | 2019-11-19 |
| 1629537279 | Jaima Suzanne Price | Hearing Instrument Specialist | 106 E Watauga Avenue, Johnson City, TN 37601 | 2019-03-13 |
| 1275004467 | Brittany Howell | Speech-Language Pathologist | 2114 E. Fairview Ave, Johnson City, TN 37601 | 2018-12-16 |
| 1194229948 | Heather Chantel Lester | Physical Therapist | 2114 E. Fairview Avenue, Johnson City, TN 37601 | 2018-03-19 |
| 1477061869 | Patrick Conway Reynolds | Specialist/Technologist | 1081 John Robert Bell Drive, Johnson City, TN 37601 | 2018-01-19 |
| 1790201135 | Surgical Services of East Tennessee PC | Surgery | 300 East Main St., Suite 301, Johnson City, TN 37601 | 2017-08-17 |
| 1073065694 | Davina Leah Reppond | Home Health | 1204 E Myrtle Ave, Johnsoncity, TN 37601 | 2016-10-31 |
| 1003365503 | Wendi Y Minutolo | Behavioral Analyst | 403 Princeton Rd Ste 3, Johnson City, TN 37601 | 2016-09-25 |
| 1306208798 | Rachel Anne Anderson | Nurse Practitioner | 1118 East Holston Avenue, Johnson City, TN 37601 | 2016-03-24 |
| 1932560976 | Kaydee Louise Davidson | Occupational Therapist | 3209 Bristol Highway, Johnson City, TN 37601 | 2016-03-18 |
| Find all providers in zip 37601 | ||||
| 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 | 37601 |
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.