Healthcare Provider Details

I. General information

NPI: 1184573784
Provider Name (Legal Business Name): STEPHENSON GUT VITALITY & HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2026
Last Update Date: 05/03/2026
Certification Date: 05/03/2026
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 Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: EMILY STEPHENSON
Title or Position: APRN
Credential: FNP-BC
Phone: 217-778-2188