Provider Demographics
NPI:1578714580
Name:STEPANEK, KELLY D (NP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:D
Last Name:STEPANEK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MANNING DR
Mailing Address - Street 2:CB 7085
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7085
Mailing Address - Country:US
Mailing Address - Phone:984-974-1931
Mailing Address - Fax:984-974-2216
Practice Address - Street 1:101 MANNING DR
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-0001
Practice Address - Country:US
Practice Address - Phone:984-974-1931
Practice Address - Fax:984-974-2216
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC199986363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7004296Medicaid
NC2593444Medicare PIN