Healthcare Provider Details

I. General information

NPI: 1083986624
Provider Name (Legal Business Name): JEANNETTA STEPHENS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2012
Last Update Date: 11/09/2022
Certification Date: 11/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 ENGLAND DR
COOKEVILLE TN
38501-0924
US

IV. Provider business mailing address

1100 ENGLAND DR
COOKEVILLE TN
38501-0924
US

V. Phone/Fax

Practice location:
  • Phone: 931-646-7575
  • Fax:
Mailing address:
  • Phone: 931-520-4466
  • Fax: 931-520-3871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number16439
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: