Dewitt, Stephanie Kim

Dewitt, Stephanie Kim is an individual health care provider with primary practice located at 620 Skyline Dr , Jackson TN 38301-3923. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Dewitt, Stephanie Kim can be contacted via phone (731) 541-5000.

Contact Information

Primary practice address
620 Skyline Dr Jackson TN 38301-3923
Phone: (731) 541-5000
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 20407 Tennessee

Profile Details

NPI number 1518337534
LBN Legal business name Dewitt, Stephanie Kim
Credentials NP-C
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 2nd, 2015
Last updated Oct 2nd, 2015 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1518337534 NPPES
Tennessee MEDICAID 0650197

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