MEDICARE: STEPHANIE WATERS RN

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	163W00000X	Registered Nurse	224651	TN

General Provider Information

NPI Number	:	1821951518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE WATERS RN

Provider Business Mailing Address
First Line	:	89 FRENCH ST
Second Line	:
City	:	GOODLETTSVILLE
State	:	TN
Zip	:	37072-1645
Country	:	US
Telephone Number	:	615-756-9275
Fax Number	:

Provider Business Practice Location Address
First Line	:	89 FRENCH ST
Second Line	:
City	:	GOODLETTSVILLE
State	:	TN
Zip	:	37072-1645
Country	:	US
Telephone Number	:	615-756-9275
Fax Number	:

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

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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