Provider Demographics
NPI:1033651914
Name:STEPHENS, ADRIENNE D (MSECS)
Entity Type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:D
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:MSECS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 W SHELTON ST LOT 1
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:AR
Mailing Address - Zip Code:71655-4732
Mailing Address - Country:US
Mailing Address - Phone:870-228-2096
Mailing Address - Fax:
Practice Address - Street 1:306 W SHELTON ST LOT 1
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:AR
Practice Address - Zip Code:71655-4732
Practice Address - Country:US
Practice Address - Phone:870-228-2096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist