Provider Demographics
NPI:1972194926
Name:STEPHENSON, DANIEL LYNN (FNP-C)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:LYNN
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 1:501 BUTLER FARM RD STE I
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-1777
Mailing Address - Country:US
Mailing Address - Phone:757-251-7469
Mailing Address - Fax:757-251-7470
Practice Address - Street 1:205 BULIFANTS BLVD STE A
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-5740
Practice Address - Country:US
Practice Address - Phone:757-345-5876
Practice Address - Fax:757-345-0770
Is Sole Proprietor?:No
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024179448363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner