Provider Demographics
NPI:1558728931
Name:APPALACHIAN HEALTH CARE, INC
Entity Type:Organization
Organization Name:APPALACHIAN HEALTH CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTIONER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:CLEVER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:423-282-2516
Mailing Address - Street 1:1009 LARK ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-8217
Mailing Address - Country:US
Mailing Address - Phone:423-282-2516
Mailing Address - Fax:423-282-3743
Practice Address - Street 1:1009 LARK ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-8217
Practice Address - Country:US
Practice Address - Phone:423-282-2516
Practice Address - Fax:423-282-3743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-15
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8014363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP67421Medicare UPIN