OrganizationActive
East Tennessee State University
NPI 1033344007 · Primary Care Nurse Practitioner · Gray, TN
Provider details
- NPI number
- 1033344007
- Entity type
- Organization
- Primary specialty
- Primary Care Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
- Organization subpart
- No
- Authorized official
- Betty King, Acting Chief Financial Officer(423) 439-4414
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Practice location
1440 Suncrest Dr
Gray, TN 37615-4118
Phone: (423) 477-1634
Fax: (423) 477-1625
Approximate (ZIP-level) locationGet directions
Mailing address
365 Stout Drive Box 70403
Johnson City, TN 37614-1703
Other names (DBA / former)
- Doing business as
- Daniel Boone High School Based Clinic
Registry dates
- Enumerated
- 2009-05-20
- Last updated
- 2017-02-23
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.