Provider Demographics
NPI:1598320210
Name:STOVALL, SARITA FELICIA (NP)
Entity Type:Individual
Prefix:
First Name:SARITA
Middle Name:FELICIA
Last Name:STOVALL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5777
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37802-5777
Mailing Address - Country:US
Mailing Address - Phone:865-246-2104
Mailing Address - Fax:865-246-2106
Practice Address - Street 1:736 ROUTE 4
Practice Address - Street 2:
Practice Address - City:SINAJANA
Practice Address - State:GU
Practice Address - Zip Code:96910-3368
Practice Address - Country:US
Practice Address - Phone:671-649-7232
Practice Address - Fax:833-514-6826
Is Sole Proprietor?:No
Enumeration Date:2019-05-08
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25774363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology