Provider Demographics
NPI:1790736841
Name:GIVEN, STACEY A (NP)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:A
Last Name:GIVEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:A
Other - Last Name:AHLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2771 HIGHWAY 11 E STE 1
Mailing Address - Street 2:
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37772-6381
Mailing Address - Country:US
Mailing Address - Phone:865-816-3393
Mailing Address - Fax:865-816-3410
Practice Address - Street 1:2771 HIGHWAY 11 E STE 1
Practice Address - Street 2:
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37772-6381
Practice Address - Country:US
Practice Address - Phone:865-816-3393
Practice Address - Fax:865-816-3410
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000006671363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1790736841Medicaid
TN3345625Medicare ID - Type Unspecified