Healthcare Provider Details

I. General information

NPI: 1639653884
Provider Name (Legal Business Name): STACY FLOWERS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STACY SHEREE TIPTON

II. Dates (important events)

Enumeration Date: 09/23/2018
Last Update Date: 11/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5616 BRAINERD RD STE 108
CHATTANOOGA TN
37411-5377
US

IV. Provider business mailing address

1311 VIRGINIA AVE SW
CLEVELAND TN
37311-2536
US

V. Phone/Fax

Practice location:
  • Phone: 423-803-1379
  • Fax: 855-699-6867
Mailing address:
  • Phone: 423-716-5412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000024455
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: