MEDICARE: STEPHANIE HUSKINS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VX0000X	Obstetrics Physician	RN0000141617	TN

General Provider Information

NPI Number	:	1104242262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE HUSKINS

Provider Business Mailing Address
First Line	:	6845 MOUNTAIN VIEW RD
Second Line	:
City	:	OOLTEWAH
State	:	TN
Zip	:	37363-6561
Country	:	US
Telephone Number	:	423-910-0896
Fax Number	:	423-910-1183

Provider Business Practice Location Address
First Line	:	6845 MOUNTAIN VIEW RD
Second Line	:
City	:	OOLTEWAH
State	:	TN
Zip	:	37363-6561
Country	:	US
Telephone Number	:	423-910-0896
Fax Number	:	423-910-1183

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2014
Last Update Date	:	06/23/2016

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Directions to “ STEPHANIE HUSKINS ” Practice Location

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