Provider Demographics
NPI:1972212298
Name:AUSTIN PEAY STATE UNIVERSITY BOYD HEALTH SERVICES
Entity Type:Organization
Organization Name:AUSTIN PEAY STATE UNIVERSITY BOYD HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT DIRECTOR, HEALTH SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:DEGRAAUW
Authorized Official - Suffix:
Authorized Official - Credentials:APRN FNP-BC
Authorized Official - Phone:931-221-7111
Mailing Address - Street 1:PO BOX 4655
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37044-0001
Mailing Address - Country:US
Mailing Address - Phone:931-221-7107
Mailing Address - Fax:931-221-7388
Practice Address - Street 1:524 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-3255
Practice Address - Country:US
Practice Address - Phone:931-221-7107
Practice Address - Fax:931-221-7388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health