Provider Demographics
NPI:1235110206
Name:STONE, BETTY L (PAC)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:L
Last Name:STONE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1409
Mailing Address - Street 2:
Mailing Address - City:NEW TAZEWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37824-1409
Mailing Address - Country:US
Mailing Address - Phone:423-626-7297
Mailing Address - Fax:423-626-5553
Practice Address - Street 1:309 N BROAD ST
Practice Address - Street 2:
Practice Address - City:NEW TAZEWELL
Practice Address - State:TN
Practice Address - Zip Code:37825-6600
Practice Address - Country:US
Practice Address - Phone:423-626-7297
Practice Address - Fax:423-626-5553
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA0000000671363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S72370Medicare UPIN