Provider Demographics
NPI:1871007146
Name:STEVENS, BENJAMIN ROBERT (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:ROBERT
Last Name:STEVENS
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 1:715 BONDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-2204
Mailing Address - Country:US
Mailing Address - Phone:616-644-5560
Mailing Address - Fax:
Practice Address - Street 1:122 W JOHN CARPENTER FWY STE 105
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-2024
Practice Address - Country:US
Practice Address - Phone:972-378-0383
Practice Address - Fax:972-403-3434
Is Sole Proprietor?:No
Enumeration Date:2017-11-25
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1035992363LF0000X
OHAPRN.CNP.022013363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily