Provider Demographics
NPI:1831899061
Name:SHANDS, STACEY MILLER (RN)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:MILLER
Last Name:SHANDS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38068-0188
Mailing Address - Country:US
Mailing Address - Phone:901-465-5243
Mailing Address - Fax:904-465-5245
Practice Address - Street 1:90 YUM YUM RD
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38068-4541
Practice Address - Country:US
Practice Address - Phone:901-465-5243
Practice Address - Fax:901-465-5245
Is Sole Proprietor?:No
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN257739163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health