Healthcare Provider Details

I. General information

NPI: 1689384950
Provider Name (Legal Business Name): JHENSIE ALEXA STEVENS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2022
Last Update Date: 11/28/2024
Certification Date: 11/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 BROADWAY # D10-38
ELMHURST NY
11373-1329
US

IV. Provider business mailing address

7901 BROADWAY # D10-38
ELMHURST NY
11373-1329
US

V. Phone/Fax

Practice location:
  • Phone: 718-334-3570
  • Fax: 718-334-5006
Mailing address:
  • Phone: 718-334-3570
  • Fax: 718-334-5006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number807038
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number405914
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: