Provider Demographics
NPI:1811916786
Name:STEPHENS, JEFF (NP)
Entity type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:MR
Other - First Name:JEFF
Other - Middle Name:M
Other - Last Name:STEPHENS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5234 AIRPORT RD NW # 200
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012-1603
Mailing Address - Country:US
Mailing Address - Phone:540-563-8000
Mailing Address - Fax:
Practice Address - Street 1:5234 AIRPORT RD NW # 200
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-1603
Practice Address - Country:US
Practice Address - Phone:540-563-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA258312279E0002X
VA0024177544363LF0000X
CANPF8322207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2279E0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredEmergency Care
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN429732Medicaid
CARN429732Medicaid