=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619271277
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEFANI D NEVILS NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/22/2010
-----------------------------------------------------
Last Update Date | 11/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 185 HOSPITAL RD
-----------------------------------------------------
City | WINCHESTER
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37398-2404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 931-967-8251
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6734 LA CHRISTA WAY
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37921-2139
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-361-8910
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LN0000X
-----------------------------------------------------
Taxonomy Name | Neonatal Nurse Practitioner
-----------------------------------------------------
License Number | APN15474
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------