MEDICARE: JESSICA M. STEPHENS PNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	708869	TX
2	363LF0000X	Family Nurse Practitioner	AP120603	TX

General Provider Information

NPI Number	:	1003100363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA M. STEPHENS PNP

Provider Business Mailing Address
First Line	:	3750 COMMERCIAL AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78221-3117
Country	:	US
Telephone Number	:	210-922-7000
Fax Number	:	210-924-4107

Provider Business Practice Location Address
First Line	:	4507 MEDICAL DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-4401
Country	:	US
Telephone Number	:	210-692-0234
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2011
Last Update Date	:	12/10/2021

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