Provider Demographics
NPI:1184750044
Name:MCCANN, STEPHEN CRAIG (NP)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:CRAIG
Last Name:MCCANN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2539 VIKING DR STE 101
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-2165
Mailing Address - Country:US
Mailing Address - Phone:183-747-8100
Mailing Address - Fax:183-747-8150
Practice Address - Street 1:5390 BARKSDALE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71112-4526
Practice Address - Country:US
Practice Address - Phone:318-747-8105
Practice Address - Fax:318-747-8150
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA221908363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1184750044OtherNPI