Healthcare Provider Details

I. General information

NPI: 1972379329
Provider Name (Legal Business Name): JESSICA KAY STEVENS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2023
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42825 32ND ST
PAW PAW MI
49079-9511
US

IV. Provider business mailing address

42825 32ND ST
PAW PAW MI
49079-9511
US

V. Phone/Fax

Practice location:
  • Phone: 269-615-3145
  • Fax:
Mailing address:
  • Phone: 269-615-3145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704318547
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: