Healthcare Provider Details

I. General information

NPI: 1801853635
Provider Name (Legal Business Name): STEPHANIE A HULL PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 12/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 CHAMBLISS AVE NW EMERGENCY DEPARTMENT
CLEVELAND TN
37311-3847
US

IV. Provider business mailing address

108 HOLLY TRL NW
CLEVELAND TN
37311-1074
US

V. Phone/Fax

Practice location:
  • Phone: 423-559-6000
  • Fax:
Mailing address:
  • Phone: 570-847-4187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1346
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: