Provider Demographics
NPI:1942754858
Name:PURVIS, STEPHANIE (NP)
Entity Type:Individual
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First Name:STEPHANIE
Middle Name:
Last Name:PURVIS
Suffix:
Gender:F
Credentials:NP
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Other - Credentials:
Mailing Address - Street 1:105 W STONE DR
Mailing Address - Street 2:SUITE 6A
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3365
Mailing Address - Country:US
Mailing Address - Phone:423-408-7220
Mailing Address - Fax:423-408-7405
Practice Address - Street 1:127 HEALTH CARE DR
Practice Address - Street 2:SUITE 8
Practice Address - City:PENNINGTON GAP
Practice Address - State:VA
Practice Address - Zip Code:24277-2853
Practice Address - Country:US
Practice Address - Phone:276-546-5212
Practice Address - Fax:276-546-1525
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-09
Last Update Date:2017-02-01
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Provider Licenses
StateLicense IDTaxonomies
VA0024173789363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVVM825B288Medicare PIN