Provider Demographics
NPI:1851805477
Name:STEPHENSON, BRIAN RICHARD (FNP-C)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:RICHARD
Last Name:STEPHENSON
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 N WYATT DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2121
Mailing Address - Country:US
Mailing Address - Phone:520-616-1510
Mailing Address - Fax:520-616-1511
Practice Address - Street 1:2325 N WYATT DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2121
Practice Address - Country:US
Practice Address - Phone:520-616-1510
Practice Address - Fax:520-616-1511
Is Sole Proprietor?:No
Enumeration Date:2017-11-17
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID72177363LF0000X
AZAP10800363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily