Healthcare Provider Details

I. General information

NPI: 1508177593
Provider Name (Legal Business Name): AMANDA J STEPHENS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2010
Last Update Date: 09/26/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S NEW BALLAS RD STE 2007B
SAINT LOUIS MO
63141-8265
US

IV. Provider business mailing address

621 S NEW BALLAS RD STE 2007B
SAINT LOUIS MO
63141-8265
US

V. Phone/Fax

Practice location:
  • Phone: 314-991-5000
  • Fax: 314-991-5035
Mailing address:
  • Phone: 314-991-5000
  • Fax: 314-991-5035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number2017014187
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: