NPIMap

Organization Active NPI

Stonebridge Medical Group, PLC

  • Adult Health Nurse Practitioner
  • Jackson, TN
National Provider Identifier
1487977369
Registry record updated Mar 8, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
APN7239 Issued in TN
Legal business name
STONEBRIDGE MEDICAL GROUP, PLC
Practice address
111 Stonebridge Blvd
Suite B
Jackson, TN 38305-2040
Phone
(731) 661-1008
Fax
(731) 410-6778
NPI assigned
Mar 8, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Jeffrey W Young Jr., FNP
Title
Owner
Phone
(731) 661-1008

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LA2200X APN7239 TN Primary

Addresses

Primary practice location

111 Stonebridge Blvd
Suite B
Jackson, TN 38305-2040

Mailing address

PO Box 1798
Dept. 07-100
Memphis, TN 38101-1798
Phone (731) 661-1008

National Provider Directory

National Provider Directory

Locations

111 Stonebridge Blvd
Ste B
Jackson, TN 38305
Phone (731) 610-1008

Practitioners & affiliated clinicians

Practitioners 26

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 26

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1268006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268006400000",
    "number": "1487977369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1798",
            "address_2": "DEPT. 07-100",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381011798",
            "telephone_number": "731-661-1008",
            "fax_number": "731-410-6778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 STONEBRIDGE BLVD",
            "address_2": "SUITE B",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383052040",
            "telephone_number": "731-661-1008",
            "fax_number": "731-410-6778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STONEBRIDGE MEDICAL GROUP, PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-08",
        "last_updated": "2010-03-08",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "731-661-1008",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "TN",
            "license": "APN7239",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.