Healthcare Provider Details

I. General information

NPI: 1053531012
Provider Name (Legal Business Name): STACY MICHELLE STEPHENSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 01/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 ALCOA HWY SUITE 235
KNOXVILLE TN
37920-1500
US

IV. Provider business mailing address

PO BOX 440445
NASHVILLE TN
37244-0445
US

V. Phone/Fax

Practice location:
  • Phone: 865-305-4670
  • Fax: 865-305-4671
Mailing address:
  • Phone: 865-670-6199
  • Fax: 865-670-6198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number50600
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberP17006
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: