Healthcare Provider Details

I. General information

NPI: 1609870393
Provider Name (Legal Business Name): LINDA STOVER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 09/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

457 VISTA DR
SPARTA TN
38583-1360
US

IV. Provider business mailing address

330 FRANKLIN RD. #135A-393
BRENTWOOD TN
37027
US

V. Phone/Fax

Practice location:
  • Phone: 931-738-4595
  • Fax: 931-738-4596
Mailing address:
  • Phone: 615-309-3300
  • Fax: 615-309-3338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number102477
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: