Provider Demographics
NPI:1619446812
Name:STEVENS, JAY DON (FNP-C)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:DON
Last Name:STEVENS
Suffix:
Gender:M
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 1:1133 W KANSAS ST
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-2281
Mailing Address - Country:US
Mailing Address - Phone:816-781-7400
Mailing Address - Fax:816-781-3315
Practice Address - Street 1:1133 W KANSAS ST
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-2281
Practice Address - Country:US
Practice Address - Phone:816-781-7400
Practice Address - Fax:816-781-3315
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-16
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018031757363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily