Provider Demographics
NPI:1609286004
Name:STUBBLEFIELD, ERIN MICHELE (PA-C)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:MICHELE
Last Name:STUBBLEFIELD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:979 E 3RD ST STE C825
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-3357
Mailing Address - Country:US
Mailing Address - Phone:423-778-4830
Mailing Address - Fax:
Practice Address - Street 1:4370 MEDICAL ARTS DR STE 295
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1742
Practice Address - Country:US
Practice Address - Phone:972-691-3777
Practice Address - Fax:972-691-3666
Is Sole Proprietor?:No
Enumeration Date:2014-05-07
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3225363AM0700X
TN4159363AM0700X
TXPA08931363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4159OtherMEDICAL LICENSE
TXPA08931OtherMEDICAL LICENSE