Provider Demographics
NPI:1609870393
Name:STOVER, LINDA (FNP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:STOVER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 FRANKLIN RD. #135A-393
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027
Mailing Address - Country:US
Mailing Address - Phone:615-309-3300
Mailing Address - Fax:615-309-3338
Practice Address - Street 1:457 VISTA DR
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:TN
Practice Address - Zip Code:38583-1360
Practice Address - Country:US
Practice Address - Phone:931-738-4595
Practice Address - Fax:931-738-4596
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN102477207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3342452Medicaid
TN3342452Medicaid
TN3342452Medicare ID - Type Unspecified