Provider Demographics
NPI:1871823021
Name:HINKLE, STEPHANIE R (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:R
Last Name:HINKLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:LUITHLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3173 43RD STREET S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-4564
Mailing Address - Country:US
Mailing Address - Phone:701-478-8780
Mailing Address - Fax:218-773-6861
Practice Address - Street 1:3173 43RD STREET S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-4564
Practice Address - Country:US
Practice Address - Phone:701-478-8780
Practice Address - Fax:218-773-6861
Is Sole Proprietor?:No
Enumeration Date:2010-01-12
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDPAC0419363A00000X, 363AM0700X
MN10695363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1871823021Medicaid
ND71063Medicaid