Healthcare Provider Details

I. General information

NPI: 1174266043
Provider Name (Legal Business Name): STEPHANIE MARIE MAUPIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2022
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

874 UNION AVE RM 325
MEMPHIS TN
38103-3514
US

IV. Provider business mailing address

874 UNION AVE RM 325
MEMPHIS TN
38103-3514
US

V. Phone/Fax

Practice location:
  • Phone: 901-448-6128
  • Fax:
Mailing address:
  • Phone: 901-448-6128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number37951
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: