Healthcare Provider Details

I. General information

NPI: 1760417943
Provider Name (Legal Business Name): MARY BETH STILL APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 03/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 PRINCETON ROAD WASHINGTON COUNTY HEALTH DEPARTMENT
JOHNSON CITY TN
37601
US

IV. Provider business mailing address

219 PRINCETON ROAD WASHINGTON COUNTY HEALTH DEPARTMENT
JOHNSON CITY TN
37601
US

V. Phone/Fax

Practice location:
  • Phone: 423-975-2200
  • Fax: 423-975-2210
Mailing address:
  • Phone: 423-975-2200
  • Fax: 423-975-2210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number7606
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: