Healthcare Provider Details

I. General information

NPI: 1073594263
Provider Name (Legal Business Name): STACEY ANNE KESTERSON RNC MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 N BELLWOOD RD
MORRISTOWN TN
37814-1188
US

IV. Provider business mailing address

305 N BELLWOOD RD
MORRISTOWN TN
37814-1188
US

V. Phone/Fax

Practice location:
  • Phone: 865-471-2700
  • Fax: 865-471-2704
Mailing address:
  • Phone: 865-471-2700
  • Fax: 865-471-2704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number96945
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: