Provider Demographics
NPI:1710579388
Name:SOWELL, STACIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:
Last Name:SOWELL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 WOODBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38068-1242
Mailing Address - Country:US
Mailing Address - Phone:901-465-6353
Mailing Address - Fax:833-902-3599
Practice Address - Street 1:25 WOODBRIDGE RD
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38068-1242
Practice Address - Country:US
Practice Address - Phone:901-465-6353
Practice Address - Fax:833-902-3599
Is Sole Proprietor?:No
Enumeration Date:2021-02-05
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29045363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner