Individual
STACEY LOUISE VALLEJO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4230 HARDING RD, SUITE 400, NASHVILLE, TN 37205-2013
(615) 297-2700
(615) 269-4584
Mailing address
104 WOODMONT BLVD, SUITE LL50, NASHVILLE, TN 37205-2245
(615) 386-2300
(615) 386-2399
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
039104
TN
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
039104
TN
207RP1001X
Pulmonary Disease Physician
Primary
039104
TN
207RP1001X
Pulmonary Disease Physician
28958
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01354639
AMERIGROUP
TN
01
—
1437936
CIGNA
TN
05
—
1517642
—
TN
01
—
4265773
BLUE CROSS/ BLUE SHIELD
TN
05
—
7100119610
—
KY
01
—
9106527
AETNA
TN
01
—
P00837678
MEDICARE RR
TN
Enumeration date
10/14/2006
Last updated
05/21/2015
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