Healthcare Provider Details

I. General information

NPI: 1568390581
Provider Name (Legal Business Name): DARREL EARL STEPHENS I
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 S 7TH ST
LINCOLN NE
68502-2001
US

IV. Provider business mailing address

1420 S 7TH ST
LINCOLN NE
68502-2001
US

V. Phone/Fax

Practice location:
  • Phone: 480-943-6433
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License NumberH13065657
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: