Healthcare Provider Details

I. General information

NPI: 1205468949
Provider Name (Legal Business Name): STEPHEN THOMAS FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2020
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 N JACKSON ST STE 300
TULLAHOMA TN
37388-2293
US

IV. Provider business mailing address

3841 GREEN HILLS VILLAGE DR STE 200
NASHVILLE TN
37215-2691
US

V. Phone/Fax

Practice location:
  • Phone: 931-455-8676
  • Fax:
Mailing address:
  • Phone: 615-691-0839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number27135
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: