Basic Information
| Provider Information | |||||||||
| NPI: | 1609870393 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STOVER | ||||||||
| FirstName: | LINDA | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 330 FRANKLIN RD. #135A-393 | ||||||||
| Address2: | |||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153093300 | ||||||||
| FaxNumber: | 6153093338 | ||||||||
| Practice Location | |||||||||
| Address1: | 457 VISTA DR | ||||||||
| Address2: | |||||||||
| City: | SPARTA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 385831360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9317384595 | ||||||||
| FaxNumber: | 9317384596 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2005 | ||||||||
| LastUpdateDate: | 09/25/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 102477 | TN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3342452 | 05 | TN | MEDICAID |