Provider Demographics
NPI:1659810935
Name:DEVERS, STEPHANIE GALE (CPNP-PC, NNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:GALE
Last Name:DEVERS
Suffix:
Gender:F
Credentials:CPNP-PC, NNP-BC
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:GALE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:52 JOHNNY WORTHAM RD
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-4823
Mailing Address - Country:US
Mailing Address - Phone:678-859-8441
Mailing Address - Fax:
Practice Address - Street 1:52 JOHNNY WORTHAM RD
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-4823
Practice Address - Country:US
Practice Address - Phone:678-859-8441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-19
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN160287363LP0200X, 363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics