Healthcare Provider Details

I. General information

NPI: 1841371747
Provider Name (Legal Business Name): RACHEL L. STEVENS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 JOEL DR
FORT CAMPBELL KY
42223-5318
US

IV. Provider business mailing address

1206 WILLOW BEND DR
CLARKSVILLE TN
37043-1715
US

V. Phone/Fax

Practice location:
  • Phone: 270-798-4677
  • Fax:
Mailing address:
  • Phone: 931-906-9390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11934
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: