Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mountain States Health Alliance

Organization Pediatrics Physician · NPI 1124426259

Mountain States Health Alliance is a Pediatrics Physician in Johnson City, Tennessee. Registered with an NPI since 2014.

In the registry since
2014
Specialties on file
3

Practice location Address checks out

400 N State Of Franklin Rd Niswonger Children's Hospital Admin
Johnson City, TN 37604-6035
Phone: (423) 431-4847
Fax: (423) 431-3949
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pediatrics Physician (primary) Taxonomy 208000000X
Pediatric Critical Care Medicine Physician Taxonomy 2080P0203X
Pediatric Nurse Practitioner Taxonomy 363LP0200X

Record details

NPI number1124426259
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Mary Krutak — Evp/Cfo · (423) 302-3423
NPI enumeratedDecember 5, 2014
Last updated in NPPESFebruary 26, 2018
Mailing address311 Princeton Rd Ste 1, Johnson City, TN 37601-2026

Other providers in Johnson City