Individual
MRS. STACIE K GRANTHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CFNP
Contact information
Practice address
587 SKYLINE DR, JACKSON, TN 38301-3938
(731) 424-8922
(731) 423-2922
Mailing address
587 SKYLINE DR, JACKSON, TN 38301-3938
(731) 424-8922
(731) 423-2922
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
13513
TN
363LF0000X
Family Nurse Practitioner
APN13513
TN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
APN13513
TN
Other
Enumeration date
01/29/2009
Last updated
09/07/2021
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