Provider Demographics
NPI:1689244030
Name:STEPHENS, MICHAELA (FNP-C)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:F
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 1:3201 HARGROVE RD E APT 3003
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405-3460
Mailing Address - Country:US
Mailing Address - Phone:205-777-9181
Mailing Address - Fax:
Practice Address - Street 1:4960 RICE MINE RD NE STE 10
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-3136
Practice Address - Country:US
Practice Address - Phone:205-777-9181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-151768363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily