Healthcare Provider Details

I. General information

NPI: 1295640324
Provider Name (Legal Business Name): STEFANI ANNETT APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E MAIN ST
JOHNSON CITY TN
37601-4877
US

IV. Provider business mailing address

401 E MAIN ST
JOHNSON CITY TN
37601-4877
US

V. Phone/Fax

Practice location:
  • Phone: 423-929-2584
  • Fax: 423-722-2060
Mailing address:
  • Phone: 423-929-2584
  • Fax: 423-722-2060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number42470
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: