1053531012 NPI number — DR. STACY MICHELLE STEPHENSON MD

Table of content: DR. STACY MICHELLE STEPHENSON MD (NPI 1053531012)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053531012 NPI number — DR. STACY MICHELLE STEPHENSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEPHENSON
Provider First Name:
STACY
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053531012
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/30/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 440445
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37244-0445
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-670-6199
Provider Business Mailing Address Fax Number:
865-670-6198

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1930 ALCOA HWY
Provider Second Line Business Practice Location Address:
SUITE 235
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37920-1500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-305-4670
Provider Business Practice Location Address Fax Number:
865-305-4671
Provider Enumeration Date:
05/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  P17006 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208200000X , with the licence number: 50600 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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