Healthcare Provider Details

I. General information

NPI: 1326453473
Provider Name (Legal Business Name): STACIE L MCCRAY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2014
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 BRISTOL WEST BLVD STE 2C
BRISTOL TN
37620-8773
US

IV. Provider business mailing address

222 2ND AVE S FL 17
NASHVILLE TN
37201-2366
US

V. Phone/Fax

Practice location:
  • Phone: 423-844-1399
  • Fax: 423-844-1397
Mailing address:
  • Phone: 888-731-8994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number149505
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18892
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024171883
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: