Provider Demographics
NPI:1376135798
Name:CHADWICK, STEPHANIE LYNE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:LYNE
Last Name:CHADWICK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2992 ODUM SCREVEN RD
Mailing Address - Street 2:
Mailing Address - City:SCREVEN
Mailing Address - State:GA
Mailing Address - Zip Code:31560-9537
Mailing Address - Country:US
Mailing Address - Phone:912-294-2859
Mailing Address - Fax:
Practice Address - Street 1:3345 US HIGHWAY 84 STE 102
Practice Address - Street 2:
Practice Address - City:BLACKSHEAR
Practice Address - State:GA
Practice Address - Zip Code:31516-2160
Practice Address - Country:US
Practice Address - Phone:912-228-1358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-08
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN169513363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily