Healthcare Provider Details

I. General information

NPI: 1275413783
Provider Name (Legal Business Name): STACY HANSON CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2025
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1651 GUNBARREL RD STE 101A
CHATTANOOGA TN
37421-3289
US

IV. Provider business mailing address

4976 ALPHA LN
HIXSON TN
37343-5470
US

V. Phone/Fax

Practice location:
  • Phone: 423-899-9133
  • Fax:
Mailing address:
  • Phone: 423-497-5355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number39655
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: