STACEY NELSON (NPI# 1770839029) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770839029 |
| Entity Type | Individual |
| Full Name | STACEY NELSON |
| Other Name | STACEY LEANN RIDDLEY |
| Credential | PMHNP-BC |
| Practice Address |
1704 E Broadway Ave Maryville TN 37804 |
| Mailing Address |
201 W Springdale Ave Knoxville TN 37917-5158 |
| Practice Telephone | 8656816990 |
| Mailing Telephone | 8656379711 |
| Enumeration Date | 2012-07-24 |
| Last Update Date | 2020-01-29 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163W00000X | Registered Nurse | RN0000175851 | TN | Nursing Service Providers |
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
APN22481 | TN | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | Q027970 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922489723 | Stacey D Nelson | Social Worker | 11048 Cardiff Ln, Frisco, TX 75035-6673 | 2015-06-17 |
| 1215346259 | Stacey Nelson | Counselor | 4215 9th Ave S, Fargo, ND 58103-2018 | 2014-08-04 |
| 1740546050 | Stacey Nelson | Licensed Practical Nurse | 2634 Pearl St, Detroit, MI 48209-3700 | 2012-04-11 |
| 1609942655 | Stacey Nelson | Social Worker | 4371 E 72nd Ave, Commerce City, CO 80022-1471 | 2006-11-28 |
| 1033293279 | Stacey J Nelson | Marriage & Family Therapist | 1200 N Federal Hwy Ste 200, Boca Raton, FL 33432-2813 | 2006-10-24 |
| 1598204109 | Stacey Nelson | Registered Nurse | 777 Murphy Rd, Medford, OR 97504-8425 | 2017-02-15 |
| 1225384589 | Stacey White Nelson | Counselor | 1307 E Elm St, Athens, AL 35611-5318 | 2012-07-24 |
| 1760790828 | Stacey Lynn Nelson | Psychologist | 11280 86th Ave N, Maple Grove, MN 55369-4510 | 2010-09-22 |
| 1912187329 | Stacey Lynn Nelson | Nurse Anesthetist, Certified Registered | 77 W Forest Ave Ste 117, Flagstaff, AZ 86001-1482 | 2007-11-14 |
| 1538292834 | Stacey Nelson | Counselor | 914 E Broadway, Louisville, KY 40204-1037 | 2007-03-14 |
| Street Address |
1704 E BROADWAY AVE |
| City | MARYVILLE |
| State | TN |
| Zip Code | 37804 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033299102 | Sharon N Chastain | Psychiatry & Neurology | 1704 E Broadway Ave, Maryville, TN 37804-2916 | 2006-10-16 |
| 1780297002 | Graham Scott Paschall | Social Worker | 1704 E Broadway Ave, Maryville, TN 37804-2916 | 2020-08-26 |
| 1710597463 | Traci Michelle Forsyth | Case Manager/Care Coordinator | 1704 E Broadway Ave, Maryville, TN 37804-2916 | 2020-08-07 |
| 1063030278 | Stephanie Moncrief | Counselor | 1704 E Broadway Ave, Maryville, TN 37804-2916 | 2020-07-14 |
| 1689292567 | Rachelle Leigh Bennett Baker | Counselor | 1704 E Broadway Ave, Maryville, TN 37804-2916 | 2020-07-08 |
| 1093330037 | Bryon Edward Hart | Counselor | 1704 E Broadway Ave, Maryville, TN 37804-2916 | 2020-06-16 |
| 1811522477 | Eden Flanders | Technician, Health Information | 1704 E Broadway Ave, Maryville, TN 37804-2916 | 2020-03-04 |
| 1326679721 | Hillary Stephens Hays | Counselor | 1704 E Broadway Ave, Maryville, TN 37804-2916 | 2020-02-04 |
| 1558992768 | Becki Grace Livingston | Counselor | 1704 E Broadway Ave, Maryville, TN 37804-2916 | 2020-01-28 |
| 1932757846 | Tabatha Campbell | Student in an Organized Health Care Education/Training Program | 1704 E Broadway Ave, Maryville, TN 37804-2916 | 2019-09-04 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659835825 | Matthew David Mallory | Physical Therapist | Morning View Village 2320 E. Lamar Alexander Parway, Maryville, TN 37804 | 2019-01-22 |
| 1063937290 | Rachel Ryan Mcmillan | Counselor | 362 High Street, Maryville, TN 37804 | 2017-08-09 |
| 1316461460 | Steven Casey Boring | Nurse Practitioner | 907 E. Lamar Alexander Pkwy., Maryville, TN 37804 | 2017-07-31 |
| 1851738751 | Robert Kane Mccall | Pathology | 250 E. Broadway, Maryville, TN 37804 | 2013-05-31 |
| 1619242849 | Jennifer Mcclements | Physical Therapy Assistant | 4004 Samuel Circle, Maryville, TN 37804 | 2012-03-21 |
| 1316223886 | Sabrina Nicole Powers | Social Worker | 1704 East Broadway, Maryville, TN 37804 | 2011-10-28 |
| 1407138381 | Russmann, Inc. | Ambulance | 4163 Benny Delozier Drive, Maryville, TN 37804 | 2011-09-15 |
| 1184932485 | Complete Family Care of Maryville, Pllc | Internal Medicine | 2004 E. Broadway, Maryville, TN 37804 | 2010-09-21 |
| 1093975096 | Kristi Clark Correll | Speech-Language Pathologist | 2030 East Lamar Alexander Parkway, Maryville, TN 37804 | 2008-06-12 |
| 1134388267 | Barbara Frantz Poulsen | Speech-Language Pathologist | 2030 E Lamar Alexander Parkway, Maryville, TN 37804 | 2008-06-04 |
| Find all providers in zip 37804 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568086288 | William George Blaker | Nurse Practitioner | 1551 Cavalier Dr, Maryville, TN 37803-9206 | 2020-05-29 |
| 1952804791 | Mountain View Mental Health, LLC | Nurse Practitioner | 4233 Old Niles Ferry Rd, Maryville, TN 37801-0643 | 2018-03-16 |
| 1134622418 | Kelli Morrison | Nurse Practitioner | 907 E Lamar Alexander Pkwy, Maryville, TN 37804-5015 | 2018-03-13 |
| 1487157095 | Mary Salerno | Nurse Practitioner | 1620 E Lamar Alexander Pkwy, Maryville, TN 37804-6205 | 2018-03-10 |
| 1770849127 | Linda Fullington Cabage | Nurse Practitioner | 659 Morganton Square Dr, Maryville, TN 37801-4763 | 2012-04-10 |
| 1386957330 | Beverly Hancock | Nurse Practitioner | 210 Simmons St, Maryville, TN 37801-4750 | 2010-07-20 |
| 1245559962 | Sheila Gail White | Nurse Practitioner | 108 Jess Cir, Maryville, TN 37801-0692 | 2010-05-20 |
| 1619119740 | Knoxville Apns LLC | Nurse Practitioner | 108 Jess Cir, Maryville, TN 37801-0692 | 2009-04-06 |
| 1912975186 | Benjamin R Kadas | Nurse Practitioner | 627 Smithview Dr, Maryville, TN 37803-6100 | 2006-03-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659972966 | Rebecca Singleton | Nurse Practitioner | 2601 N John B Dennis Hwy Apt 2318, Kingsport, TN 37660-0835 | 2020-11-03 |
| 1205434503 | Sonya Lavet Butler | Nurse Practitioner | 3413 Axelwood Dr, Murfreesboro, TN 37128-3984 | 2020-10-09 |
| 1417554361 | John Pearson Redmond | Nurse Practitioner | 1710 Ghost Creek Dr, Collierville, TN 38017-3425 | 2020-10-05 |
| 1861099061 | Justin Mccord | Nurse Practitioner | 454 Red Hill Center Rd, Lawrenceburg, TN 38464-6842 | 2020-10-01 |
| 1265049977 | Toya Owens | Nurse Practitioner | 2565 Mackinnon Dr, Memphis, TN 38119-7903 | 2020-09-26 |
| 1043827041 | Zamaria Davion Louise Gains | Nurse Practitioner | 7405 Shallowford Rd Ste 230, Chattanooga, TN 37421-7632 | 2020-09-24 |
| 1376158998 | Mary L Dean Turner | Nurse Practitioner | 6727 Stonetrace Dr, Bartlett, TN 38135-3054 | 2020-09-10 |
| 1205447794 | Sana Pathan | Nurse Practitioner | 829 S Sherbrooke Cir, Mount Carmel, TN 37645-4019 | 2020-08-10 |
| 1093325557 | Highland Behavioral Healthcare | Nurse Practitioner | 29 Taylor Ave Ste 204, Crossville, TN 38555-4537 | 2020-08-08 |
| 1225648009 | Angela R Davenport | Nurse Practitioner | 7110 Crossroads Blvd, Brentwood, TN 37027-2826 | 2020-08-05 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.