Provider Demographics
NPI:1578507950
Name:STEVENS, CHRISTY LENORE (DO)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:LENORE
Last Name:STEVENS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37662-0009
Mailing Address - Country:US
Mailing Address - Phone:423-857-2066
Mailing Address - Fax:
Practice Address - Street 1:105 W STONE DR
Practice Address - Street 2:STE 2B
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3365
Practice Address - Country:US
Practice Address - Phone:423-247-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TND01802207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3319938Medicaid
VAC06181Medicare PIN
TN3319938Medicare UPIN
TN103I161897Medicare PIN
VAMC10596Medicare UPIN
TN3700592Medicare PIN
TN103I162882Medicare PIN