Provider Demographics
NPI:1740741990
Name:STEPHENS, HALIE DAWNE (NP-C)
Entity type:Individual
Prefix:
First Name:HALIE
Middle Name:DAWNE
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6799 GREAT OAKS RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38138-2588
Mailing Address - Country:US
Mailing Address - Phone:901-827-9435
Mailing Address - Fax:
Practice Address - Street 1:6799 GREAT OAKS RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38138-2588
Practice Address - Country:US
Practice Address - Phone:901-261-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-29
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25820363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health