Healthcare Provider Details

I. General information

NPI: 1720261316
Provider Name (Legal Business Name): JILL STINSON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2007
Last Update Date: 08/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 DEROSIER DR
JOHNSON CITY TN
37614-5200
US

IV. Provider business mailing address

PO BOX 699
MOUNTAIN HOME TN
37684-0699
US

V. Phone/Fax

Practice location:
  • Phone: 423-439-7777
  • Fax: 423-439-7780
Mailing address:
  • Phone: 423-433-6039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2007020134
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: