Healthcare Provider Details

I. General information

NPI: 1114723814
Provider Name (Legal Business Name): KATIE STEPHENSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2025
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 SE 18TH ST STE 602
OCALA FL
34471-5472
US

IV. Provider business mailing address

PO BOX 102222
ATLANTA GA
30368-2222
US

V. Phone/Fax

Practice location:
  • Phone: 352-369-0181
  • Fax: 352-369-0246
Mailing address:
  • Phone: 239-274-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9119962
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: