Healthcare Provider Details

I. General information

NPI: 1003541962
Provider Name (Legal Business Name): EMILY STEPHENSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2022
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 E CHESTER ST STE 106
CHAMPAIGN IL
61820-4116
US

IV. Provider business mailing address

PO BOX 43
MAHOMET IL
61853-0043
US

V. Phone/Fax

Practice location:
  • Phone: 217-778-2188
  • Fax: 888-252-7228
Mailing address:
  • Phone: 217-778-2188
  • Fax: 888-252-7228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number277.003970
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277.003970
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number277.003970
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number277.003970
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: