Provider Demographics
NPI:1790250389
Name:STEVENSON, AUDRA CAMILLE (RN)
Entity Type:Individual
Prefix:
First Name:AUDRA
Middle Name:CAMILLE
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:AUDRA
Other - Middle Name:CAMILLE
Other - Last Name:HYLTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:530 SAVANNAH DR
Mailing Address - Street 2:
Mailing Address - City:OVILLA
Mailing Address - State:TX
Mailing Address - Zip Code:75154-3325
Mailing Address - Country:US
Mailing Address - Phone:214-493-9020
Mailing Address - Fax:
Practice Address - Street 1:530 SAVANNAH DR
Practice Address - Street 2:
Practice Address - City:OVILLA
Practice Address - State:TX
Practice Address - Zip Code:75154-3325
Practice Address - Country:US
Practice Address - Phone:214-493-9020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX947639163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse