MEDICARE: MRS. CHESSICA D STEPHNEY R.D., C.D.E.

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	133V00000X	Registered Dietitian	1807	TN

General Provider Information

NPI Number	:	1194860197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHESSICA D STEPHNEY R.D., C.D.E.

Provider Business Mailing Address
First Line	:	3225 HARCOURT WAY APT 201
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38119-3107
Country	:	US
Telephone Number	:	901-309-1830
Fax Number	:

Provider Business Practice Location Address
First Line	:	2996 KATE BOND RD STE 413
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38133-4063
Country	:	US
Telephone Number	:	901-384-0065
Fax Number	:	901-266-1165

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

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	07/08/2007

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