Healthcare Provider Details

I. General information

NPI: 1902633092
Provider Name (Legal Business Name): JULIE STEPHENS PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2024
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

695 S BROADWAY ST
COAL CITY IL
60416-1705
US

IV. Provider business mailing address

454 NORTH ST
ESSEX IL
60935-6111
US

V. Phone/Fax

Practice location:
  • Phone: 815-214-9162
  • Fax: 815-208-2194
Mailing address:
  • Phone: 815-703-4301
  • Fax: 815-208-2194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209029885
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: