Provider Demographics
NPI:1346418183
Name:NINAN, STACY DIANE (APN)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:DIANE
Last Name:NINAN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:DIANE
Other - Last Name:KELLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:PO BOX 1165
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37088-1165
Mailing Address - Country:US
Mailing Address - Phone:615-257-0900
Mailing Address - Fax:615-443-1444
Practice Address - Street 1:1423 W BADDOUR PKWY
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-3061
Practice Address - Country:US
Practice Address - Phone:615-257-0900
Practice Address - Fax:615-443-1444
Is Sole Proprietor?:No
Enumeration Date:2008-02-14
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000013199363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care