Provider Demographics
NPI:1104242262
Name:HUSKINS, STEPHANIE
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:HUSKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6845 MOUNTAIN VIEW RD
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6561
Mailing Address - Country:US
Mailing Address - Phone:423-910-0896
Mailing Address - Fax:423-910-1183
Practice Address - Street 1:6845 MOUNTAIN VIEW RD
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-6561
Practice Address - Country:US
Practice Address - Phone:423-910-0896
Practice Address - Fax:423-910-1183
Is Sole Proprietor?:No
Enumeration Date:2014-03-13
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000141617207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics