Healthcare Provider Details

I. General information

NPI: 1922238435
Provider Name (Legal Business Name): STEPHANIE L KEFER MSN, FNP-BC, CNOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2009
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11108 PARKVIEW CIRCLE DR. SUITE 5100
FORT WAYNE IN
46845-1707
US

IV. Provider business mailing address

11109 PARKVIEW PLAZA DR # 117
FORT WAYNE IN
46845-1701
US

V. Phone/Fax

Practice location:
  • Phone: 260-266-2800
  • Fax: 260-266-2805
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71002980A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: