Provider Demographics
NPI:1043267404
Name:REVELS, STEPHANIE MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:MARIE
Last Name:REVELS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:102 WOODMONT BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-5250
Mailing Address - Country:US
Mailing Address - Phone:615-314-5257
Mailing Address - Fax:615-692-0547
Practice Address - Street 1:3135 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64128-1552
Practice Address - Country:US
Practice Address - Phone:816-209-1237
Practice Address - Fax:816-577-5091
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2022-08-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS04-28042207Q00000X
MOR3H32207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKA2049Medicare PIN