Provider Demographics
NPI:1003496563
Name:SILL, STEPHANIE FOWLKES (NP)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:FOWLKES
Last Name:SILL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6919 TULANE AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3532
Mailing Address - Country:US
Mailing Address - Phone:804-647-0433
Mailing Address - Fax:
Practice Address - Street 1:1011 JOHNSTON WILLIS DR STE 200
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-4808
Practice Address - Country:US
Practice Address - Phone:804-288-2742
Practice Address - Fax:804-288-9053
Is Sole Proprietor?:No
Enumeration Date:2021-04-09
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11012466363LA2100X
VA0024183219363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care