MEDICARE: STEPHEN MILSTEAD PMHNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	243712	TX

General Provider Information

NPI Number	:	1306195912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN MILSTEAD PMHNP

Provider Business Mailing Address
First Line	:	1111 INDUSTRIAL BLVD
Second Line	:	BLDG #2
City	:	ABILENE
State	:	TX
Zip	:	79602-7929
Country	:	US
Telephone Number	:	325-795-9140
Fax Number	:

Provider Business Practice Location Address
First Line	:	1111 INDUSTRIAL BLVD
Second Line	:	BLDG #2
City	:	ABILENE
State	:	TX
Zip	:	79602-7929
Country	:	US
Telephone Number	:	325-795-9140
Fax Number	:

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

Provider Enumeration Date	:	08/29/2012
Last Update Date	:	07/18/2013

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