Provider Demographics
NPI:1699390351
Name:STEPHENS, NICOLE LEE (PA-C)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:LEE
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 E BACON ST
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-3908
Mailing Address - Country:US
Mailing Address - Phone:570-573-9092
Mailing Address - Fax:
Practice Address - Street 1:3000 ST LUKES DR
Practice Address - Street 2:
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951-1696
Practice Address - Country:US
Practice Address - Phone:570-573-9092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-09
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant