Provider Demographics
NPI:1497841977
Name:GRIFFIN, STEPHANIE K (CRNP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:K
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7605 COUNTY ROAD 47
Mailing Address - Street 2:
Mailing Address - City:RAINSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35986
Mailing Address - Country:US
Mailing Address - Phone:256-657-6335
Mailing Address - Fax:
Practice Address - Street 1:323 MEDICAL CENTER DR. S.W.
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35968-3420
Practice Address - Country:US
Practice Address - Phone:256-997-9016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1071430363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51501391OtherBCBS OF AL
AL891002050Medicaid
AL891002050Medicaid
AL51501391OtherBCBS OF AL