Provider Demographics
NPI:1225523673
Name:ANDERSON, STEFANIE K (APRN PMHNP-BC FNP-C)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:K
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:APRN PMHNP-BC FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5976 W KIDD CABIN CIR
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84096-7465
Mailing Address - Country:US
Mailing Address - Phone:801-560-1853
Mailing Address - Fax:
Practice Address - Street 1:74 S MAIN ST
Practice Address - Street 2:
Practice Address - City:GUNNISON
Practice Address - State:UT
Practice Address - Zip Code:84634-7706
Practice Address - Country:US
Practice Address - Phone:801-753-8038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-28
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5631885-4405363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily