Provider Demographics
NPI:1821095977
Name:STEPHENS, DEBRA LYNN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:LYNN
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3011 W SMOKEY ROW RD
Mailing Address - Street 2:STE. A
Mailing Address - City:BARGERSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46106-8803
Mailing Address - Country:US
Mailing Address - Phone:317-535-0453
Mailing Address - Fax:318-535-0467
Practice Address - Street 1:3011 W SMOKEY ROW RD
Practice Address - Street 2:STE. A
Practice Address - City:BARGERSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46106-8803
Practice Address - Country:US
Practice Address - Phone:317-535-0453
Practice Address - Fax:318-535-0467
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28062242A163W00000X
IN71000422A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200405900Medicaid
IN200168550AMedicaid