Healthcare Provider Details

I. General information

NPI: 1740879493
Provider Name (Legal Business Name): SYDNEY P STEVENS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SYDNEY P COOPER PA-C

II. Dates (important events)

Enumeration Date: 01/15/2021
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7210 W MAIN ST
BELLEVILLE IL
62223-3038
US

IV. Provider business mailing address

7210 W MAIN ST
BELLEVILLE IL
62223-3038
US

V. Phone/Fax

Practice location:
  • Phone: 618-398-8840
  • Fax: 618-398-8847
Mailing address:
  • Phone: 618-398-8840
  • Fax: 618-398-8847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085008912
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2026016788
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: