Healthcare Provider Details

I. General information

NPI: 1952271900
Provider Name (Legal Business Name): STEPHANIE ANNE DOTY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2025
Last Update Date: 04/12/2026
Certification Date: 04/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 W. STREET SUITE B
STOCKTON MO
65785
US

IV. Provider business mailing address

506 N CHICAGO AVE
BOLIVAR MO
65613-1724
US

V. Phone/Fax

Practice location:
  • Phone: 417-754-0224
  • Fax:
Mailing address:
  • Phone: 417-298-1042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number2025041925
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: