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NPI Code Detail

MEDICARE: MRS. DEMETRIA KRISTEN STOWE B.S.

MEDICARE: MRS. DEMETRIA KRISTEN STOWE B.S.
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
1320800000XMental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number : 1255563904
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DEMETRIA KRISTEN STOWE B.S.
Provider Business Mailing Address
First Line : 521 ROTARY HILLS CT
Second Line :
City : CLARKSVILLE
State : TN
Zip : 37043-3905
Country : US
Telephone Number : 931-237-8694
Fax Number :
Provider Business Practice Location Address
First Line : 118 UNION ST
Second Line :
City : CLARKSVILLE
State : TN
Zip : 37040-5115
Country : US
Telephone Number : 931-647-8257
Fax Number : 931-647-2978
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2009
Last Update Date : 08/17/2009

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