Provider Demographics
NPI:1841614229
Name:STEPHENS, TREVOR (PA)
Entity Type:Individual
Prefix:
First Name:TREVOR
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2552 ELDORADO PKWY STE 550
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-8630
Mailing Address - Country:US
Mailing Address - Phone:469-495-9114
Mailing Address - Fax:
Practice Address - Street 1:2552 ELDORADO PKWY STE 550
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-8630
Practice Address - Country:US
Practice Address - Phone:469-495-9114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-06
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08780363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant