Provider Demographics
NPI:1710325162
Name:STEPHENS, CHERYL FISH (FNP)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:FISH
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5238
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29804-5238
Mailing Address - Country:US
Mailing Address - Phone:803-649-5300
Mailing Address - Fax:803-649-0056
Practice Address - Street 1:102 SUMMERWOOD WAY
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-7704
Practice Address - Country:US
Practice Address - Phone:803-649-5300
Practice Address - Fax:803-649-0056
Is Sole Proprietor?:No
Enumeration Date:2013-06-07
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18273363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily