Provider Demographics
NPI:1164518502
Name:NELSON, STACIE (NP)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:144 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:COPPERHILL
Mailing Address - State:TN
Mailing Address - Zip Code:37317-5005
Mailing Address - Country:US
Mailing Address - Phone:423-496-9214
Mailing Address - Fax:423-496-7809
Practice Address - Street 1:144 MEDICAL CENTER DR
Practice Address - Street 2:SUITE B
Practice Address - City:COPPERHILL
Practice Address - State:TN
Practice Address - Zip Code:37317-5005
Practice Address - Country:US
Practice Address - Phone:423-496-9214
Practice Address - Fax:423-496-7809
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN129463NP363LA2200X
TN17242363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health