Provider Demographics
NPI:1114648656
Name:STEVENS, TINA I
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:I
Last Name:STEVENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16882 ST. RT. 138 CLARKSBURG OHIO 43115
Mailing Address - Street 2:16882 ST. RT. 138
Mailing Address - City:CLARKSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43115
Mailing Address - Country:US
Mailing Address - Phone:740-600-8000
Mailing Address - Fax:
Practice Address - Street 1:765 SHERMAN RD
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-1361
Practice Address - Country:US
Practice Address - Phone:740-600-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X
OH3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant