Provider Demographics
NPI:1467838599
Name:STOCKWELL, ERIN LYNN (NP)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:LYNN
Last Name:STOCKWELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:LYNN
Other - Last Name:YEARGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:4543 FREDONIA ROAD
Mailing Address - Street 2:
Mailing Address - City:DUNLAP
Mailing Address - State:TN
Mailing Address - Zip Code:37327-6715
Mailing Address - Country:US
Mailing Address - Phone:423-949-3305
Mailing Address - Fax:
Practice Address - Street 1:2000 STEIN DR
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-7217
Practice Address - Country:US
Practice Address - Phone:423-648-8480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-30
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20222363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner