Healthcare Provider Details

I. General information

NPI: 1457995375
Provider Name (Legal Business Name): VERONICA LEVETTE STUKES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2019
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 POLIFKA DR
SHAW AFB SC
29152-5100
US

IV. Provider business mailing address

420 POLIFKA DR BLDG 1042
SHAW AFB SC
29152-5100
US

V. Phone/Fax

Practice location:
  • Phone: 803-895-6356
  • Fax:
Mailing address:
  • Phone: 803-895-6425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number23193
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: