Provider Demographics
NPI:1467809327
Name:BECKETT, STEPHANIE J (APRN)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:J
Last Name:BECKETT
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6965 CUMBERLAND GAP PKWY STE 315
Mailing Address - Street 2:
Mailing Address - City:HARROGATE
Mailing Address - State:TN
Mailing Address - Zip Code:37752-8245
Mailing Address - Country:US
Mailing Address - Phone:423-869-6249
Mailing Address - Fax:423-869-6675
Practice Address - Street 1:6965 CUMBERLAND GAP PKWY STE 315
Practice Address - Street 2:
Practice Address - City:HARROGATE
Practice Address - State:TN
Practice Address - Zip Code:37752-8245
Practice Address - Country:US
Practice Address - Phone:423-869-6249
Practice Address - Fax:423-869-6675
Is Sole Proprietor?:No
Enumeration Date:2016-05-20
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000363LF0000X
KY3011263363LF0000X
TN21294363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK226260Medicare PIN