DAVID CROCKETT HIGH SCHOOL BASED HEALTH CLINIC
NPI 1508091562
Nurse Practitioner - Primary Care in Jonesborough, TN

Q: What is East Tennessee State University's NPI number?

The NPI number for East Tennessee State University is 1508091562. It was assigned to this organization in the NPPES registry on May 20, 2009. The provider is doing business as David Crockett High School Based Health Clinic.

Q: What is East Tennessee State University's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Primary Care, with taxonomy code 363LP2300X.

Active since May 20, 2009CLIA 44D2171891 · Waiver

684 OLD STATE ROUTE 34, JONESBOROUGH, TN 37659(423) 753-0057(423) 753-1167 Get Directions Write a Review

NPPES record last updated: February 23, 2017. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About David Crockett High School Based Health Clinic NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DAVID CROCKETT HIGH SCHOOL BASED HEALTH CLINIC (NPI 1508091562) is a healthcare organization registered as a primary care in Jonesborough, Tennessee and active in the NPI registry since May 2009. The organization holds a CLIA Waiver certificate valid through September 9, 2027 and lists Betty J. King, Acting Chief Financial Officer, as its authorized official.

NPPES Registry Identity

NPI1508091562

Entity TypeOrganization

Primary Taxonomy363LP2300X

Legal Business NameEAST TENNESSEE STATE UNIVERSITY

Location Address684 OLD STATE ROUTE 34Jonesborough, TN 37659-6094

Mailing Address365 Stout Drive Box 70403Johnson City, TN 37614-1703 · (423) 439-4071 · Fax (423) 439-4060

Phone(423) 753-0057

Fax(423) 753-1167

Organization SubpartNo

Authorized OfficialBetty J. KingActing Chief Financial Officer · (423) 439-4414

Enumeration DateMay 20, 2009

Last NPPES UpdateFebruary 23, 2017

✔ NPI 1508091562 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Primary CarePhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LP2300X

684 OLD STATE ROUTE 34, Jonesborough, TN 37659

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Other Names 1

Doing Business AsDavid Crockett High School Based Health Clinic

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 44D2171891

David Crockett High School · Jonesborough, TN

Active · expires Sep 9, 2027

CLIA Number44D2171891

Laboratory TypeSchool/Student Health Service

Certificate Effective DateSeptember 10, 2025

Certificate Expiration DateSeptember 9, 2027

Laboratory DirectorDr. Timothy Schwob

Laboratory Phone(423) 547-5218

Laboratory LocationDavid Crockett High School684 Old State Route 34, Jonesborough, TN 37659

CLIA data matches this NPI record on: Address Name

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

GEORGE BALLOU BARRETT ATC

Specialist/Technologist (Athletic Trainer)

684 OLD STATE ROUTE 34
JONESBOROUGH, TN 37659

Washington County (423) 753-1150

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is East Tennessee State University's NPI number?

The NPI number for East Tennessee State University is 1508091562. It was assigned to this organization in the NPPES registry on May 20, 2009. The provider is doing business as David Crockett High School Based Health Clinic.

Where is East Tennessee State University located?

East Tennessee State University is located at 684 Old State Route 34, Jonesborough, TN 37659. The listed phone number is (423) 753-0057.

What is East Tennessee State University's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Primary Care, with taxonomy code 363LP2300X.

Does East Tennessee State University hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 44D2171891) is associated with this NPI, valid through September 9, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for East Tennessee State University was last updated on February 23, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.