Healthcare Provider Details

I. General information

NPI: 1083523054
Provider Name (Legal Business Name): DEBORAH STITT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

723 TENNESSEE AVE
BRISTOL TN
37620-3853
US

IV. Provider business mailing address

723 TENNESSEE AVE
BRISTOL TN
37620-3853
US

V. Phone/Fax

Practice location:
  • Phone: 423-429-1156
  • Fax:
Mailing address:
  • Phone: 423-429-1156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number180747
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: