Healthcare Provider Details

I. General information

NPI: 1205358090
Provider Name (Legal Business Name): STEPHANIE JILL TONEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2017
Last Update Date: 07/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 GREENCASTLE DR
JACKSON TN
38305-3835
US

IV. Provider business mailing address

169 GREENCASTLE DR
JACKSON TN
38305-3835
US

V. Phone/Fax

Practice location:
  • Phone: 731-282-1282
  • Fax:
Mailing address:
  • Phone: 731-298-1282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number22671
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: