Provider Demographics
NPI:1093718264
Name:BINKLEY, STACEY L (NP)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:L
Last Name:BINKLEY
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 CEDAR CREEK RD
Mailing Address - Street 2:
Mailing Address - City:VANLEER
Mailing Address - State:TN
Mailing Address - Zip Code:37181-5107
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1930 CEDAR CREEK RD
Practice Address - Street 2:
Practice Address - City:VANLEER
Practice Address - State:TN
Practice Address - Zip Code:37181-5107
Practice Address - Country:US
Practice Address - Phone:615-441-4530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN7397363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ026409Medicaid
TN4104478OtherBLUE CROSS BLUE SHIELD TN
500014543OtherRAILROAD MEDICARE PIN
TN3906476Medicaid
TN4104478OtherBLUE CROSS BLUE SHIELD TN