Healthcare Provider Details

I. General information

NPI: 1487176913
Provider Name (Legal Business Name): JENNIFER MARIA STEWART HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2017
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8480 US HIGHWAY 64
BARTLETT TN
38133-4187
US

IV. Provider business mailing address

8480 US HIGHWAY 64
BARTLETT TN
38133-4187
US

V. Phone/Fax

Practice location:
  • Phone: 901-373-4800
  • Fax:
Mailing address:
  • Phone: 901-373-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number908
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: