Provider Demographics
NPI:1598775330
Name:STEPHENS, OLIVIA (PA)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 MOHAWK ST
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-1941
Mailing Address - Country:US
Mailing Address - Phone:251-476-2556
Mailing Address - Fax:251-378-8778
Practice Address - Street 1:117 MOHAWK ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-1941
Practice Address - Country:US
Practice Address - Phone:251-476-2556
Practice Address - Fax:251-378-8778
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA-407363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant