Individual
JENNIFER STACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
350 BLOUNTVILLE HWY STE 105, BRISTOL, TN 37620-1676
(423) 797-5504
(423) 797-4486
Mailing address
350 BLOUNTVILLE HWY STE 105, BRISTOL, TN 37620-1676
(423) 797-5505
(423) 797-4486
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
23778
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q036117
—
TN
Enumeration date
02/13/2018
Last updated
02/14/2024
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