Provider Demographics
NPI:1821715509
Name:STEPHENS, SHANTELLE ALICIA (ARNP)
Entity type:Individual
Prefix:
First Name:SHANTELLE
Middle Name:ALICIA
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:SHANTELLE
Other - Middle Name:ALICIA
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:550 GAGE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-9532
Mailing Address - Country:US
Mailing Address - Phone:509-473-0637
Mailing Address - Fax:509-627-2983
Practice Address - Street 1:3900 S ZINTEL WAY STE 110
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99337-5092
Practice Address - Country:US
Practice Address - Phone:509-942-3125
Practice Address - Fax:509-585-8173
Is Sole Proprietor?:No
Enumeration Date:2022-10-24
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60850819163WP0200X
WAAP61538886363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics