Healthcare Provider Details

I. General information

NPI: 1174404107
Provider Name (Legal Business Name): STEPHANIE ELAINE WALKER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 W BLACKWELL ST
TULLAHOMA TN
37388-3505
US

IV. Provider business mailing address

94 KIWI DR
WINCHESTER TN
37398-5517
US

V. Phone/Fax

Practice location:
  • Phone: 931-841-3821
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number39685
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: