Healthcare Provider Details

I. General information

NPI: 1487438529
Provider Name (Legal Business Name): MATHEW W STEPHENS FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 CALIFORNIA ST STE A
REDDING CA
96001-1953
US

IV. Provider business mailing address

3675 WASATCH DR
REDDING CA
96001-2968
US

V. Phone/Fax

Practice location:
  • Phone: 530-247-7070
  • Fax: 530-247-7246
Mailing address:
  • Phone: 219-929-7610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95026509
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: