Provider Demographics
NPI:1629646880
Name:STEPHENSON, BROOKLYN S (RN)
Entity Type:Individual
Prefix:
First Name:BROOKLYN
Middle Name:S
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 HIGHWAY 52 BYP E
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37083-1009
Mailing Address - Country:US
Mailing Address - Phone:615-666-2142
Mailing Address - Fax:615-666-6135
Practice Address - Street 1:601 HIGHWAY 52 BYP E
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:TN
Practice Address - Zip Code:37083-1009
Practice Address - Country:US
Practice Address - Phone:615-666-2142
Practice Address - Fax:615-666-6135
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN242717163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse