Provider Demographics
NPI:1902391139
Name:STEPHENS, KIMBERLY C (MSN APRN FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:C
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:MSN APRN FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 BLANDING BLVD
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-8917
Mailing Address - Country:US
Mailing Address - Phone:904-276-1133
Mailing Address - Fax:904-276-1821
Practice Address - Street 1:865 BLANDING BLVD
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-8917
Practice Address - Country:US
Practice Address - Phone:904-276-1133
Practice Address - Fax:904-276-1821
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-29
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9362511363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily