Healthcare Provider Details

I. General information

NPI: 1851622237
Provider Name (Legal Business Name): STACEY HINKLE P.A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2010
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11808 KINGSTON PIKE STE 160
KNOXVILLE TN
37934-3838
US

IV. Provider business mailing address

1275 DICK LONAS RD
KNOXVILLE TN
37909-1382
US

V. Phone/Fax

Practice location:
  • Phone: 865-966-3940
  • Fax:
Mailing address:
  • Phone: 865-258-4474
  • Fax: 865-381-1509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2457
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number006735
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2457
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: