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General NPI Number Information
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NPI Number | 1104775253
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Entity Type | Individual
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Provider Name | BROOKE LYNN STACKPOLE H.I.S.
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Gender | Female
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Dates
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Enumeration Date | 01/22/2026
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Last Update Date | 01/22/2026
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Provider Practice Location Address
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Address Line | 1630 S CHURCH ST STE 116
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City | MURFREESBORO
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State | TN
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Zip | 37130-5554
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Country | US
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Telephone | 615-709-6682
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Fax | 615-713-3355
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Provider Business Mailing Address
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Address Line | 1620 BATTLEGROUND DR APT A5
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City | MURFREESBORO
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State | TN
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Zip | 37129-1777
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Country | US
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Telephone | 615-709-6682
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Fax | 615-713-3355
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 1055
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License Number State | TN
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