Healthcare Provider Details

I. General information

NPI: 1003790387
Provider Name (Legal Business Name): STEPHANIE DEANNA MCCALLISTER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE DEANNA BAILEY RN

II. Dates (important events)

Enumeration Date: 08/01/2025
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 LILYFIELD LN
GALLOWAY OH
43119-8037
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 614-323-1989
  • Fax:
Mailing address:
  • Phone: 614-366-5671
  • Fax: 614-366-5671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0039902
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: