MEDICARE: KRISTA STEPHENSON

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	2086X0206X	Surgical Oncology Physician	V1273	TX
2	208600000X	Surgery Physician	V1273	TX
3	208600000X	Surgery Physician	2025-03912	NC

General Provider Information

NPI Number	:	1972034387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTA STEPHENSON

Provider Business Mailing Address
First Line	:	PO BOX 604350
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-4350
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10030 GILEAD RD STE 245
Second Line	:
City	:	HUNTERSVILLE
State	:	NC
Zip	:	28078-7545
Country	:	US
Telephone Number	:	704-895-9390
Fax Number	:

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

Provider Enumeration Date	:	03/27/2017
Last Update Date	:	03/19/2026

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Directions to “ KRISTA STEPHENSON ” Practice Location

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