Provider Demographics
NPI:1649604489
Name:EAST TENNESSEE SKILLED CARE
Entity type:Organization
Organization Name:EAST TENNESSEE SKILLED CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:EMMALEA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:423-773-9555
Mailing Address - Street 1:PO BOX 4300
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37602-4300
Mailing Address - Country:US
Mailing Address - Phone:423-773-9555
Mailing Address - Fax:423-913-4123
Practice Address - Street 1:140 TECHNOLOGY LN
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2004
Practice Address - Country:US
Practice Address - Phone:423-773-9555
Practice Address - Fax:423-913-4123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-28
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN166309163W00000X
TNAPN15811363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty