Healthcare Provider Details

I. General information

NPI: 1144502337
Provider Name (Legal Business Name): JACE LYAM STEPHENS APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2011
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 BRIARVILLE RD STE 103
MADISON TN
37115-5157
US

IV. Provider business mailing address

1309 BRIARVILLE RD STE 103
MADISON TN
37115-5157
US

V. Phone/Fax

Practice location:
  • Phone: 615-757-9577
  • Fax: 615-757-9578
Mailing address:
  • Phone: 615-757-9577
  • Fax: 615-757-9578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number16073
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: