Provider Demographics
NPI:1942210463
Name:BURGETT, STEPHANIE (NP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:BURGETT
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 1:939 EMERALD AVE
Mailing Address - Street 2:SUITE 610
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-4502
Mailing Address - Country:US
Mailing Address - Phone:865-637-8635
Mailing Address - Fax:865-637-4821
Practice Address - Street 1:939 EMERALD AVE
Practice Address - Street 2:SUITE 610
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-4502
Practice Address - Country:US
Practice Address - Phone:865-637-8635
Practice Address - Fax:865-637-4821
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000012170363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner