Healthcare Provider Details

I. General information

NPI: 1710836622
Provider Name (Legal Business Name): BIG ISLAND NEURO HEALTH FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2026
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28-1167 OLD MAMALAHOA HWY
PEPEEKEO HI
96783
US

IV. Provider business mailing address

1787 HALE O KEA ST
HILO HI
96720-5946
US

V. Phone/Fax

Practice location:
  • Phone: 702-354-2704
  • Fax:
Mailing address:
  • Phone: 702-354-2704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: JESSICA STEVENS
Title or Position: PRESIDENT / CEO
Credential: RN
Phone: 702-354-2704