Provider Demographics
NPI:1669186458
Name:STEPHENSON, BAILEY ROSE
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:ROSE
Last Name:STEPHENSON
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 1:4406 MUNGER AVE UNIT 1
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-4480
Mailing Address - Country:US
Mailing Address - Phone:817-734-4477
Mailing Address - Fax:
Practice Address - Street 1:2601 LAKESIDE PKWY STE 180
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-4291
Practice Address - Country:US
Practice Address - Phone:850-869-0551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1105215363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily