Healthcare Provider Details

I. General information

NPI: 1699358010
Provider Name (Legal Business Name): STEPHANIE WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 06/14/2021
Certification Date: 06/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2343 BRIGHTON CLOPTON RD
BRIGHTON TN
38011-7600
US

IV. Provider business mailing address

2343 BRIGHTON CLOPTON RD
BRIGHTON TN
38011-7600
US

V. Phone/Fax

Practice location:
  • Phone: 844-553-9355
  • Fax:
Mailing address:
  • Phone: 844-553-9355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1000000028433
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: