MEDICARE: MECHELE LEA STYKES HIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237700000X	Hearing Instrument Specialist	1037	TN

General Provider Information

NPI Number	:	1568167013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MECHELE LEA STYKES HIS

Provider Business Mailing Address
First Line	:	1757 FORT HENRY DR
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37664-3229
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1757 FORT HENRY DR
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37664-3229
Country	:	US
Telephone Number	:	423-239-5361
Fax Number	:	423-765-1207

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2023
Last Update Date	:	04/04/2023

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