Provider Demographics
NPI:1417511429
Name:KENTNER, STEPHANIE VALLARI (CPM,LM)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:VALLARI
Last Name:KENTNER
Suffix:
Gender:F
Credentials:CPM,LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8441 RUTHETTE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76182-3630
Mailing Address - Country:US
Mailing Address - Phone:972-632-9162
Mailing Address - Fax:
Practice Address - Street 1:1726 CHADWICK CT
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-3318
Practice Address - Country:US
Practice Address - Phone:817-479-0124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99374176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty