Healthcare Provider Details

I. General information

NPI: 1508114885
Provider Name (Legal Business Name): STEPHANIE MICHELLE HENLEY-PIPPERT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2012
Last Update Date: 04/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 E SIGLER AVE SUITE A
MEMPHIS MO
63555-1726
US

IV. Provider business mailing address

450 E SIGLER AVE SUITE A
MEMPHIS MO
63555-1726
US

V. Phone/Fax

Practice location:
  • Phone: 660-465-2828
  • Fax: 660-465-2820
Mailing address:
  • Phone: 660-465-2828
  • Fax: 660-465-2820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2012028470
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: