Healthcare Provider Details

I. General information

NPI: 1811236136
Provider Name (Legal Business Name): KEVIN ULYSSE STEPHENS SR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2013
Last Update Date: 02/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ROSEDOWN CT
NEW ORLEANS LA
70131-3313
US

IV. Provider business mailing address

1 ROSEDOWN CT
NEW ORLEANS LA
70131-3313
US

V. Phone/Fax

Practice location:
  • Phone: 504-228-4991
  • Fax: 504-433-2091
Mailing address:
  • Phone: 504-228-4991
  • Fax: 504-433-2091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number017769
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: