| Organization Name: | EAST TENNESSEE STATE UNIVERSITY |
| NPI Number: | 1033344007 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DAVID C. COLLINS (CFO, VP FINANCE & ADMINISTRATION) |
| Mailing Address: | 1440 Suncrest Dr Gray |
| State: | TN US |
| Postal Code: | 376154118 |
| Phone Number: | 4234771634 |
| Fax Number: | 4234771625 |
| NPI Enumeration Date: | 05/20/2009 |
| NPI Last Update Date: | 06/08/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP2300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |