Provider Demographics
NPI:1851005144
Name:HALES, STEPHANIE DEANS
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:DEANS
Last Name:HALES
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 1:7116 MOBLEY RD
Mailing Address - Street 2:
Mailing Address - City:LUCAMA
Mailing Address - State:NC
Mailing Address - Zip Code:27851-9056
Mailing Address - Country:US
Mailing Address - Phone:252-218-8513
Mailing Address - Fax:
Practice Address - Street 1:3520 AIRPORT BLVD NW
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896-8674
Practice Address - Country:US
Practice Address - Phone:252-206-5622
Practice Address - Fax:252-206-5623
Is Sole Proprietor?:No
Enumeration Date:2023-01-11
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5018509363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily