MEDICARE: STEPHANIE FUQUA

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1679198956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE FUQUA

Provider Business Mailing Address
First Line	:	6105 YELLOW ROSE CV
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78749-1657
Country	:	US
Telephone Number	:	972-777-1331
Fax Number	:

Provider Business Practice Location Address
First Line	:	6105 YELLOW ROSE CV
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78749-1657
Country	:	US
Telephone Number	:	972-777-1331
Fax Number	:

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

Provider Enumeration Date	:	06/11/2020
Last Update Date	:	10/27/2025

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