Healthcare Provider Details

I. General information

NPI: 1578835922
Provider Name (Legal Business Name): TERESA ELAINE STEPHENS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TERESA ELAINE STEPHENS NP

II. Dates (important events)

Enumeration Date: 02/01/2012
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5120 WESTON RD
EVANSVILLE IN
47712-3702
US

IV. Provider business mailing address

109 BRENDA DR
VINCENNES IN
47591-6513
US

V. Phone/Fax

Practice location:
  • Phone: 812-424-4811
  • Fax:
Mailing address:
  • Phone: 812-887-1031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71003860A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: