Healthcare Provider Details

I. General information

NPI: 1104775253
Provider Name (Legal Business Name): BROOKE LYNN STACKPOLE H.I.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BROOKE LYNN KELLEY

II. Dates (important events)

Enumeration Date: 01/22/2026
Last Update Date: 01/22/2026
Certification Date: 01/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 S CHURCH ST STE 116
MURFREESBORO TN
37130-5554
US

IV. Provider business mailing address

1620 BATTLEGROUND DR APT A5
MURFREESBORO TN
37129-1777
US

V. Phone/Fax

Practice location:
  • Phone: 615-709-6682
  • Fax: 615-713-3355
Mailing address:
  • Phone: 615-709-6682
  • Fax: 615-713-3355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1055
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: