Healthcare Provider Details

I. General information

NPI: 1568982601
Provider Name (Legal Business Name): STEPHANIE DEAN RICHARDS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2017
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MEDICAL DR
ELIZABETH CITY NC
27909-3361
US

IV. Provider business mailing address

100 MEDICAL DR
ELIZABETH CITY NC
27909-3361
US

V. Phone/Fax

Practice location:
  • Phone: 252-384-2600
  • Fax: 252-335-2731
Mailing address:
  • Phone: 252-384-2600
  • Fax: 252-335-2731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5024209
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024174963
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: