Provider Demographics
NPI:1619138120
Name:STEPHENS, SHINEL MOODY (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:SHINEL
Middle Name:MOODY
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MISS
Other - First Name:SHINEL
Other - Middle Name:LALICIA
Other - Last Name:MOODY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:PO BOX 19491
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707
Mailing Address - Country:US
Mailing Address - Phone:919-530-6317
Mailing Address - Fax:919-530-7969
Practice Address - Street 1:1801 FAYETTEVILLE ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707
Practice Address - Country:US
Practice Address - Phone:919-530-6317
Practice Address - Fax:919-530-7969
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201422363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily