Healthcare Provider Details

I. General information

NPI: 1467962514
Provider Name (Legal Business Name): STEPHANIE KAY HUSTON N.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STEPHANIE KAY HUSTON MYLES N.M.D.

II. Dates (important events)

Enumeration Date: 10/03/2017
Last Update Date: 10/08/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44725 N 14TH ST
NEW RIVER AZ
85087-6530
US

IV. Provider business mailing address

44725 N. 14TH ST.
NEW RIVER AZ
85087
US

V. Phone/Fax

Practice location:
  • Phone: 602-920-9614
  • Fax:
Mailing address:
  • Phone: 602-920-9614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number17-1637
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code175L00000X
TaxonomyHomeopath
License Number17-1637
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: