Provider Demographics
NPI:1821735424
Name:STEVENS, KRISTINE (AGNP-C)
Entity type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:T
Other - Last Name:GARDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, AGNP-C
Mailing Address - Street 1:11611 S FOOTHILLS BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85367-5845
Mailing Address - Country:US
Mailing Address - Phone:928-247-2275
Mailing Address - Fax:
Practice Address - Street 1:11611 S FOOTHILLS BLVD STE F
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85367-5845
Practice Address - Country:US
Practice Address - Phone:928-247-9277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ255977163W00000X, 363LA2200X, 363LG0600X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ159894Medicaid