Healthcare Provider Details

I. General information

NPI: 1316490733
Provider Name (Legal Business Name): STEPHANIE M NEAL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE M IRONS NP

II. Dates (important events)

Enumeration Date: 08/02/2016
Last Update Date: 03/27/2025
Certification Date: 11/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 LAKESHORE PARKWAY
ROCK HILL SC
29730-4205
US

IV. Provider business mailing address

PO BOX 602108
CHARLOTTE NC
28260-2108
US

V. Phone/Fax

Practice location:
  • Phone: 803-909-9083
  • Fax:
Mailing address:
  • Phone: 843-792-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5008784
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number25392
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number5008784
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: