Provider Demographics
NPI:1881946291
Name:ESTES, STEPHANIE ROSS
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ROSS
Last Name:ESTES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24523-2050
Mailing Address - Country:US
Mailing Address - Phone:804-554-0360
Mailing Address - Fax:800-914-4290
Practice Address - Street 1:309 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:VA
Practice Address - Zip Code:24523-2050
Practice Address - Country:US
Practice Address - Phone:804-554-0360
Practice Address - Fax:800-914-4209
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-09
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No333300000XSuppliersEmergency Response System Companies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0165535060Medicaid
VA0165428571Medicaid
VA0165099224Medicaid