Provider Demographics
NPI:1659815272
Name:STEPHENS, SAMMIE (APRN, NP-C)
Entity Type:Individual
Prefix:
First Name:SAMMIE
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2739 ANNELISE WAY
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-7635
Mailing Address - Country:US
Mailing Address - Phone:307-259-0601
Mailing Address - Fax:
Practice Address - Street 1:2739 ANNELISE WAY
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-7635
Practice Address - Country:US
Practice Address - Phone:307-259-0601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-16
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY17744.1578363L00000X
COAPN.0992851-NP363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CORXN.0102897-NPOtherCOLORADO BOARD OF NURSING
WY17744.1578OtherWYOMING STATE BOARD OF NURSING - ADVANCED PRACTICE REGISTERED NURSE
COAPN.0992851-NPOtherCOLORADO BOARD OF NURSING