Provider Demographics
NPI:1114220613
Name:STEVENS, BRUCE JAMIE (APRN)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:JAMIE
Last Name:STEVENS
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:DR
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:STEVENS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:6209 KNIGHTSGATE CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-0603
Mailing Address - Country:US
Mailing Address - Phone:203-693-1510
Mailing Address - Fax:938-253-3590
Practice Address - Street 1:202D MCGILL AVE NW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-4615
Practice Address - Country:US
Practice Address - Phone:704-792-2315
Practice Address - Fax:844-269-8197
Is Sole Proprietor?:No
Enumeration Date:2010-12-06
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4567363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health