Provider Demographics
NPI:1407722713
Name:BUSBEE, STEPHEN ANDREW
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:ANDREW
Last Name:BUSBEE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 WILDCAT WAY APT 206
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-5549
Mailing Address - Country:US
Mailing Address - Phone:540-539-1997
Mailing Address - Fax:
Practice Address - Street 1:421 WILDCAT WAY APT 206
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-5549
Practice Address - Country:US
Practice Address - Phone:540-539-1997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-14
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5223133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty