Provider Demographics
NPI:1669214102
Name:DUKES, STEPHANIE LATORIA (RN)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LATORIA
Last Name:DUKES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3512 MEIER DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38118-7243
Mailing Address - Country:US
Mailing Address - Phone:262-497-0790
Mailing Address - Fax:
Practice Address - Street 1:3512 MEIER DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-7243
Practice Address - Country:US
Practice Address - Phone:262-497-0790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-06
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS916942163WC1500X, 163WH0200X, 163WG0600X, 163WP0809X, 163WX0800X, 163WR0400X, 163W00000X
WI161798163WC3500X, 163WF0300X, 163WM0705X
TN4189163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WC3500XNursing Service ProvidersRegistered NurseCardiac RehabilitationGroup - Multi-Specialty
No163WF0300XNursing Service ProvidersRegistered NurseFlightGroup - Multi-Specialty
No163WG0600XNursing Service ProvidersRegistered NurseGerontologyGroup - Multi-Specialty
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No163WX0800XNursing Service ProvidersRegistered NurseOrthopedicGroup - Multi-Specialty
No163WR0400XNursing Service ProvidersRegistered NurseRehabilitation