Provider Demographics
NPI:1811317068
Name:STOVALL, JANA M (NP)
Entity type:Individual
Prefix:MRS
First Name:JANA
Middle Name:M
Last Name:STOVALL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JANA
Other - Middle Name:M
Other - Last Name:HAIDAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP FAMILY
Mailing Address - Street 1:491 MAJORS BLVD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37352-8344
Mailing Address - Country:US
Mailing Address - Phone:931-759-4727
Mailing Address - Fax:931-759-4729
Practice Address - Street 1:491 MAJORS BLVD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:TN
Practice Address - Zip Code:37352-8344
Practice Address - Country:US
Practice Address - Phone:931-759-4727
Practice Address - Fax:931-759-4729
Is Sole Proprietor?:No
Enumeration Date:2014-04-25
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18685363LF0000X, 363L00000X
TNMD017117363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ012423Medicaid
TNQD12423Medicaid