Healthcare Provider Details

I. General information

NPI: 1194844498
Provider Name (Legal Business Name): STEDMAN FAMILY CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7513 CLINTON RD.
STEDMAN NC
28391-0358
US

IV. Provider business mailing address

7513 CLINTON RD.
STEDMAN NC
28391
US

V. Phone/Fax

Practice location:
  • Phone: 910-483-7776
  • Fax: 910-483-1373
Mailing address:
  • Phone: 910-483-7776
  • Fax: 910-483-1373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number103685
License Number StateNC

VIII. Authorized Official

Name: DR. CONNIE L BROOKS-HERNANDEZ
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 910-483-7776