Provider Demographics
NPI:1245796408
Name:PAUL, STEPHANIE LAUREN
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:LAUREN
Last Name:PAUL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 MEDICAL CENTER WAY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-3257
Mailing Address - Country:US
Mailing Address - Phone:865-549-5300
Mailing Address - Fax:865-594-5833
Practice Address - Street 1:2101 MEDICAL CENTER WAY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-3257
Practice Address - Country:US
Practice Address - Phone:865-549-5300
Practice Address - Fax:865-594-5833
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker