Healthcare Provider Details

I. General information

NPI: 1639777212
Provider Name (Legal Business Name): CLARISSA NICOLE STEPHENS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CLARISSA NICOLE MORRISSEY

II. Dates (important events)

Enumeration Date: 10/15/2020
Last Update Date: 06/07/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4420 LAKE BOONE TRL
RALEIGH NC
27607-7505
US

IV. Provider business mailing address

4420 LAKE BOONE TRL
RALEIGH NC
27607-7505
US

V. Phone/Fax

Practice location:
  • Phone: 919-784-7093
  • Fax:
Mailing address:
  • Phone: 919-784-3542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5013658
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number5013658
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5013658
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number5013658
License Number StateNC
# 5
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5013658
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: