Provider Demographics
NPI:1760022891
Name:MCINTOSH, STEPHANIE BLEVINS (NP-C)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:BLEVINS
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:SPRUCE PINE
Mailing Address - State:NC
Mailing Address - Zip Code:28777-8944
Mailing Address - Country:US
Mailing Address - Phone:828-765-5677
Mailing Address - Fax:
Practice Address - Street 1:236 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:SPRUCE PINE
Practice Address - State:NC
Practice Address - Zip Code:28777-8944
Practice Address - Country:US
Practice Address - Phone:828-765-5677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5012674363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily