MEDICARE: STEPHANIE PRINCE CUNNINGHAM D.O.

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	207V00000X	Obstetrics & Gynecology Physician	K1285	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	092341901	OTHER	TX	TPI
3	10589293	OTHER	TX	CAQH
4	4133871	OTHER	TX	BLUELINK

General Provider Information

NPI Number	:	1255422259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE PRINCE CUNNINGHAM D.O.

Provider Business Mailing Address
First Line	:	2875 JIMMY JOHNSON BLVD STE 100
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77640-2002
Country	:	US
Telephone Number	:	409-729-9222
Fax Number	:	409-722-9425

Provider Business Practice Location Address
First Line	:	2875 JIMMY JOHNSON BLVD STE 100
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77640-2002
Country	:	US
Telephone Number	:	409-729-9222
Fax Number	:	409-722-9425

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

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	06/15/2026

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Directions to “ STEPHANIE PRINCE CUNNINGHAM D.O.” Practice Location

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