Provider Demographics
NPI:1538321195
Name:STEPHENS, CAROLINE ESTHER (PHD, MSN, APRN, BC)
Entity Type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:ESTHER
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:PHD, MSN, APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 VIA FLOREADO
Mailing Address - Street 2:
Mailing Address - City:ORINDA
Mailing Address - State:CA
Mailing Address - Zip Code:94563-1925
Mailing Address - Country:US
Mailing Address - Phone:209-499-5766
Mailing Address - Fax:
Practice Address - Street 1:3150 LENOX PARK BLVD STE 214
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-4396
Practice Address - Country:US
Practice Address - Phone:901-273-2368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP14103363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAS082ZOtherMEDICARE PTAN
CAAS082ZOtherMEDICARE PTAN
CA1538321195Medicare UPIN