Healthcare Provider Details

I. General information

NPI: 1881155224
Provider Name (Legal Business Name): APPALACHIAN STATE UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 HOWARD ST
BOONE NC
28608-2070
US

IV. Provider business mailing address

614 HOWARD ST
BOONE NC
28608-2070
US

V. Phone/Fax

Practice location:
  • Phone: 828-262-3100
  • Fax: 828-262-6958
Mailing address:
  • Phone: 828-262-3100
  • Fax: 828-262-6958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH D BOOTH
Title or Position: EXECUTIVE DIRECTOR
Credential: MPH, RD, LDN
Phone: 828-262-6957