Provider Demographics
NPI:1124597174
Name:BIGGERSTAFF, MARTI ALEX (FNP)
Entity Type:Individual
Prefix:
First Name:MARTI
Middle Name:ALEX
Last Name:BIGGERSTAFF
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 ANDREW ST
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:TN
Mailing Address - Zip Code:37841-6296
Mailing Address - Country:US
Mailing Address - Phone:423-569-3762
Mailing Address - Fax:
Practice Address - Street 1:402 CUMBERLAND AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:KY
Practice Address - Zip Code:40769-1238
Practice Address - Country:US
Practice Address - Phone:423-784-5771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3013131363LF0000X
TN208539363LF0000X
TN24636363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ048131Medicaid
TN208539OtherSTATE LICENSE
KY3013131OtherSTATE LICENSE
KY7100582070Medicaid
TN24636OtherSTATE LICENSE
TN24636OtherSTATE LICENSE