Provider Demographics
NPI:1679935548
Name:STEVENS, SONDRA FALICIA
Entity Type:Individual
Prefix:
First Name:SONDRA
Middle Name:FALICIA
Last Name:STEVENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1764 HIGHWAY 178 E
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:38635-9762
Mailing Address - Country:US
Mailing Address - Phone:901-308-2226
Mailing Address - Fax:901-433-9202
Practice Address - Street 1:1764 HIGHWAY 178 E
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:38635-9762
Practice Address - Country:US
Practice Address - Phone:901-308-2226
Practice Address - Fax:901-433-9202
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1000000016743251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health