Provider Demographics
NPI:1578835922
Name:STEPHENS, TERESA ELAINE (FNP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:ELAINE
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:ELAINE
Other - Last Name:STEPHENS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:109 BRENDA DR
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-6513
Mailing Address - Country:US
Mailing Address - Phone:812-887-1031
Mailing Address - Fax:
Practice Address - Street 1:5120 WESTON RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47712-3702
Practice Address - Country:US
Practice Address - Phone:812-424-4811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003860A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN71003860AOtherFNP LICENSE
IN28110649AOtherRN LICENSE
IN28110649AOtherRN LICENSE
INM400063521Medicare PIN