Provider Demographics
NPI:1710474788
Name:CLOVINSON, STEPHANIE LAKAY (ARNP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LAKAY
Last Name:CLOVINSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 RESTON METRO PLZ STE 600
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5952
Mailing Address - Country:US
Mailing Address - Phone:703-621-1501
Mailing Address - Fax:703-740-0994
Practice Address - Street 1:1900 RESTON METRO PLZ STE 600
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5952
Practice Address - Country:US
Practice Address - Phone:703-621-1501
Practice Address - Fax:703-740-0094
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2025-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024178829363LA2200X
FLARNP9371272363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner