Healthcare Provider Details

I. General information

NPI: 1366945867
Provider Name (Legal Business Name): STEVIE ANN IVEY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2018
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 MARTHA BERRY BLVD NW
ROME GA
30165-1625
US

IV. Provider business mailing address

221 TECHNOLOGY PKWY NW
ROME GA
30165-1369
US

V. Phone/Fax

Practice location:
  • Phone: 762-235-2300
  • Fax: 706-236-6491
Mailing address:
  • Phone: 762-235-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN216250
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: