Provider Demographics
NPI:1386020352
Name:NEWBERN, STACY (APRN)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:NEWBERN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 1558
Mailing Address - Street 2:
Mailing Address - City:CHINLE
Mailing Address - State:AZ
Mailing Address - Zip Code:86503-1558
Mailing Address - Country:US
Mailing Address - Phone:406-301-3941
Mailing Address - Fax:
Practice Address - Street 1:3031 MEDICAL CENTER PKWY STE B
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-4243
Practice Address - Country:US
Practice Address - Phone:615-846-8585
Practice Address - Fax:615-904-6022
Is Sole Proprietor?:No
Enumeration Date:2015-07-31
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30070363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily