Provider Demographics
NPI:1588854632
Name:STEPHENS, ANDREA L (FNP-C)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 WILLOW ST STE A
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-4264
Mailing Address - Country:US
Mailing Address - Phone:812-291-2993
Mailing Address - Fax:812-316-1117
Practice Address - Street 1:1600 WILLOW ST STE A
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-4264
Practice Address - Country:US
Practice Address - Phone:812-291-2993
Practice Address - Fax:812-316-1117
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28140893A163W00000X
IN71002451A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000531692OtherANTHEM PIN
IN200871380Medicaid
IN444530PMedicare PIN