Provider Demographics
NPI:1992919096
Name:STOOKSBERRY, AMIEE FOLEY (APRN)
Entity type:Individual
Prefix:
First Name:AMIEE
Middle Name:FOLEY
Last Name:STOOKSBERRY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 HAWKS RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MARTIN
Mailing Address - State:TN
Mailing Address - Zip Code:38237-2708
Mailing Address - Country:US
Mailing Address - Phone:731-587-3454
Mailing Address - Fax:731-587-3460
Practice Address - Street 1:215 HAWKS RD
Practice Address - Street 2:SUITE 6
Practice Address - City:MARTIN
Practice Address - State:TN
Practice Address - Zip Code:38237-2708
Practice Address - Country:US
Practice Address - Phone:731-587-3454
Practice Address - Fax:731-587-3460
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12621363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4171303OtherBCBST
TN1516678Medicaid
TN1516678Medicaid