Healthcare Provider Details

I. General information

NPI: 1306906516
Provider Name (Legal Business Name): STEPHANIE PERRETT EADS APRN, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE PERRETT HALEY NP

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 05/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 BOONE RIDGE DR SUITE 201
JOHNSON CITY TN
37615-4998
US

IV. Provider business mailing address

546 NELIA RD
GRENADA MS
38901-8066
US

V. Phone/Fax

Practice location:
  • Phone: 423-282-1480
  • Fax: 423-928-5313
Mailing address:
  • Phone: 662-609-2233
  • Fax: 662-226-9567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR854570
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: