Provider Demographics
NPI:1235506460
Name:STOVALL, HEATHER (NP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:STOVALL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 N CHANCERY ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-2048
Mailing Address - Country:US
Mailing Address - Phone:931-474-4700
Mailing Address - Fax:931-474-4701
Practice Address - Street 1:306 N CHANCERY ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-2048
Practice Address - Country:US
Practice Address - Phone:931-474-4700
Practice Address - Fax:931-474-4701
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-24
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20347363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily