Healthcare Provider Details

I. General information

NPI: 1083981864
Provider Name (Legal Business Name): THOMAS CHARLES STEVENS JR. NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2011
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 E OSBORN RD
PHOENIX AZ
85012-2313
US

IV. Provider business mailing address

511 E OSBORN RD
PHOENIX AZ
85012-2313
US

V. Phone/Fax

Practice location:
  • Phone: 602-358-5473
  • Fax:
Mailing address:
  • Phone: 602-358-5473
  • Fax: 480-718-7943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number269866
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: