Healthcare Provider Details

I. General information

NPI: 1467809327
Provider Name (Legal Business Name): STEPHANIE J BECKETT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2016
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6965 CUMBERLAND GAP PKWY STE 315
HARROGATE TN
37752-8245
US

IV. Provider business mailing address

6965 CUMBERLAND GAP PKWY STE 315
HARROGATE TN
37752-8245
US

V. Phone/Fax

Practice location:
  • Phone: 423-869-6249
  • Fax: 423-869-6675
Mailing address:
  • Phone: 423-869-6249
  • Fax: 423-869-6675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number00000
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3011263
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number21294
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: