Provider Demographics
NPI:1790370153
Name:ECKERD, STEPHANIE DORIS
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:DORIS
Last Name:ECKERD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4952 SCENIC VIEW DR
Mailing Address - Street 2:
Mailing Address - City:IRONDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35210-3316
Mailing Address - Country:US
Mailing Address - Phone:256-425-2268
Mailing Address - Fax:
Practice Address - Street 1:1720 2ND AVE S # THT422
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35294-1932
Practice Address - Country:US
Practice Address - Phone:205-975-8978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-07
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-168648163W00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse