Provider Demographics
NPI:1518099027
Name:BERNARD, STEPHANIE CARROLL (PA-C, RD)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:CARROLL
Last Name:BERNARD
Suffix:
Gender:F
Credentials:PA-C, RD
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:CAMPBELL
Other - Last Name:CARROLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD, PA-C
Mailing Address - Street 1:20893 FOWLERS MILL CIR
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-4810
Mailing Address - Country:US
Mailing Address - Phone:617-571-7194
Mailing Address - Fax:
Practice Address - Street 1:44160 SCHOLAR PLZ
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-3459
Practice Address - Country:US
Practice Address - Phone:540-542-6546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-10
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110005158363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant