Provider Demographics
NPI:1083179246
Name:STORY, MICHELLE LYNN (APRN)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LYNN
Last Name:STORY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 HIGHWAY 28
Mailing Address - Street 2:STE 100
Mailing Address - City:JASPER
Mailing Address - State:TN
Mailing Address - Zip Code:37347-3696
Mailing Address - Country:US
Mailing Address - Phone:423-939-1500
Mailing Address - Fax:423-510-9541
Practice Address - Street 1:980 HIGHWAY 28 STE 100
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TN
Practice Address - Zip Code:37347-3696
Practice Address - Country:US
Practice Address - Phone:423-939-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-01
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25465207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000OtherDO NOT HAVE