Healthcare Provider Details

I. General information

NPI: 1033546536
Provider Name (Legal Business Name): DEVAN STEVENS MS OTR, PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2013
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 RANCHO LN STE 135
LAS VEGAS NV
89106-3826
US

IV. Provider business mailing address

1620 STIRRUP DR
HENDERSON NV
89002-8824
US

V. Phone/Fax

Practice location:
  • Phone: 702-383-1958
  • Fax: 702-383-8235
Mailing address:
  • Phone: 702-578-6271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number225XP0019X
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: