Healthcare Provider Details

I. General information

NPI: 1003708074
Provider Name (Legal Business Name): RICHARD JOSEPH STEPHENS JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2025
Last Update Date: 07/16/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 OLD BUSINNESS HIGHWAY 60
VAN BUREN MO
63965
US

IV. Provider business mailing address

1011 OLD BUSINNESS HIGHWAY 60
VAN BUREN MO
63965
US

V. Phone/Fax

Practice location:
  • Phone: 573-323-2171
  • Fax:
Mailing address:
  • Phone: 573-323-2171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: