MEDICARE: STEPHEN K ERLEWINE FNP

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	174400000X	Specialist
2	363L00000X	Nurse Practitioner	A01392	AR
3	363LF0000X	Family Nurse Practitioner	AP109901	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

General Provider Information

NPI Number	:	1588668453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN K ERLEWINE FNP

Provider Business Mailing Address
First Line	:	PO BOX 1326
Second Line	:
City	:	MARSHALL
State	:	TX
Zip	:	75671-1326
Country	:	US
Telephone Number	:	903-927-3782
Fax Number	:	903-927-1764

Provider Business Practice Location Address
First Line	:	1011 S WILLIAM ST
Second Line	:
City	:	ATLANTA
State	:	TX
Zip	:	75551
Country	:	US
Telephone Number	:	903-796-2868
Fax Number	:	903-796-0826

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	06/13/2024

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