Provider Demographics
NPI:1265562102
Name:STEPHENS, LINDA M
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:M
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 CEDAR BEND DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-5378
Mailing Address - Country:US
Mailing Address - Phone:512-901-4031
Mailing Address - Fax:512-901-3937
Practice Address - Street 1:2400 CEDAR BEND DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-5378
Practice Address - Country:US
Practice Address - Phone:512-901-4031
Practice Address - Fax:512-901-3936
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO101901363L00000X
TXAP106078363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
015908OtherKAISER-COMMERCIAL NUMBER