Provider Demographics
NPI:1659965614
Name:STILES, JESSICA RENAE (NP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RENAE
Last Name:STILES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 REDDEN XING
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:TN
Mailing Address - Zip Code:37036-1405
Mailing Address - Country:US
Mailing Address - Phone:615-495-8280
Mailing Address - Fax:
Practice Address - Street 1:624 GRASSMERE PARK STE 15
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-3671
Practice Address - Country:US
Practice Address - Phone:615-333-2152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-21
Last Update Date:2021-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000027883363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health