Healthcare Provider Details

I. General information

NPI: 1336708908
Provider Name (Legal Business Name): EVONNE B STEPHENSON FNP-C, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2019
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5566 NEW VIENNA RD
NEW VIENNA OH
45159-9533
US

IV. Provider business mailing address

700 K ST NW STE 300
WASHINGTON DC
20001-5692
US

V. Phone/Fax

Practice location:
  • Phone: 704-936-5546
  • Fax:
Mailing address:
  • Phone: 833-943-5746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number024928
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.024928
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: