Basic Information
| Provider Information | |||||||||
| NPI: | 1144643461 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STOKES | ||||||||
| FirstName: | VIVIAN | ||||||||
| MiddleName: | DENISE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | FNP-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | REEVES | ||||||||
| OtherFirstName: | VIVIAN | ||||||||
| OtherMiddleName: | DENISE | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | FNP C | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | P.O. BOX 916 | ||||||||
| Address2: | 115 EAST BROOKLYN STREET | ||||||||
| City: | LINDEN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37096 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9315892104 | ||||||||
| FaxNumber: | 9315892513 | ||||||||
| Practice Location | |||||||||
| Address1: | 115 EAST BROOKLYN STREET | ||||||||
| Address2: | |||||||||
| City: | LINDEN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37096 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9315892104 | ||||||||
| FaxNumber: | 9315892513 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2014 | ||||||||
| LastUpdateDate: | 02/03/2015 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 18290 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.