=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649986126
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDSAY ANNA STOOKSBURY PA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/27/2023
-----------------------------------------------------
Last Update Date | 04/24/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1612 CHOTO MARKETS WAY
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37922-5760
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-218-7485
-----------------------------------------------------
Fax | 865-218-7486
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1612 CHOTO MARKETS WAY
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37922-5760
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-218-7485
-----------------------------------------------------
Fax | 865-218-7486
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------