MEDICARE: MS. JAMIE STEPHENS

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	163WG0600X	Gerontology Registered Nurse	295421	NC
2	363LG0600X	Gerontology Nurse Practitioner	5021578	NC

General Provider Information

NPI Number	:	1528772092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JAMIE STEPHENS

Provider Business Mailing Address
First Line	:	207 KNOB HILL DR
Second Line	:
City	:	PIKEVILLE
State	:	NC
Zip	:	27863-8242
Country	:	US
Telephone Number	:	919-222-8861
Fax Number	:

Provider Business Practice Location Address
First Line	:	207 KNOB HILL DR
Second Line	:
City	:	PIKEVILLE
State	:	NC
Zip	:	27863-8242
Country	:	US
Telephone Number	:	919-222-8867
Fax Number	:

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

Provider Enumeration Date	:	01/10/2023
Last Update Date	:	01/29/2025

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Directions to “ MS. JAMIE STEPHENS ” Practice Location

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