Provider Demographics
NPI:1144502337
Name:STEPHENS, JACE LYAM (APRN)
Entity type:Individual
Prefix:
First Name:JACE
Middle Name:LYAM
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 MAIN ST STE 127
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37206-3603
Mailing Address - Country:US
Mailing Address - Phone:615-757-9577
Mailing Address - Fax:615-757-9578
Practice Address - Street 1:615 MAIN ST STE 127
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37206-3603
Practice Address - Country:US
Practice Address - Phone:615-757-9577
Practice Address - Fax:615-757-9578
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-13
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16073363LP2300X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1526032Medicaid
TN103I500701Medicare PIN