Provider Demographics
NPI:1760417943
Name:STILL, MARY BETH (APN)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:BETH
Last Name:STILL
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 PRINCETON ROAD
Mailing Address - Street 2:WASHINGTON COUNTY HEALTH DEPARTMENT
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601
Mailing Address - Country:US
Mailing Address - Phone:423-975-2200
Mailing Address - Fax:423-975-2210
Practice Address - Street 1:219 PRINCETON ROAD
Practice Address - Street 2:WASHINGTON COUNTY HEALTH DEPARTMENT
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601
Practice Address - Country:US
Practice Address - Phone:423-975-2200
Practice Address - Fax:423-975-2210
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7606363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4259820OtherBLUECROSS BLUESHIELD OF TN
TNP74567Medicare UPIN