Provider Demographics
NPI:1891249884
Name:STEVENS, AUSTIN
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:STEVENS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 ROARKS COVE RD APT 2
Mailing Address - Street 2:
Mailing Address - City:SEWANEE
Mailing Address - State:TN
Mailing Address - Zip Code:37375-3006
Mailing Address - Country:US
Mailing Address - Phone:224-321-2427
Mailing Address - Fax:
Practice Address - Street 1:157 ROARKS COVE RD APT 2
Practice Address - Street 2:
Practice Address - City:SEWANEE
Practice Address - State:TN
Practice Address - Zip Code:37375-3006
Practice Address - Country:US
Practice Address - Phone:224-321-2427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-08
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program