Individual
JENNIFER STAKIAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
415 BROAD ST, SUITE 410, KINGSPORT, TN 37660-4263
(423) 239-9737
(423) 398-5500
Mailing address
1 MEDICAL PARK BLVD, BRISTOL, TN 37620-7430
(423) 239-9737
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
18172
TN
Other
Enumeration date
11/22/2013
Last updated
11/22/2013
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