Healthcare Provider Details

I. General information

NPI: 1841396363
Provider Name (Legal Business Name): STEPHANIE A HUTCHISON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE A COVERDELL FNP

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 MISSOURI ST
WAVERLY MO
64096-8241
US

IV. Provider business mailing address

825 S BUSINESS HIGHWAY 13
LEXINGTON MO
64067-1515
US

V. Phone/Fax

Practice location:
  • Phone: 877-344-3572
  • Fax: 866-288-4492
Mailing address:
  • Phone: 816-249-2085
  • Fax: 660-251-0524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number108949
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: