Healthcare Provider Details

I. General information

NPI: 1376127308
Provider Name (Legal Business Name): HOPE ALEXIS STEPHENS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HOPE ALEXIS LARSON

II. Dates (important events)

Enumeration Date: 05/06/2021
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5002 CROSSINGS CIR STE 180
MT JULIET TN
37122-8497
US

IV. Provider business mailing address

5002 CROSSINGS CIR STE 180
MT JULIET TN
37122-8497
US

V. Phone/Fax

Practice location:
  • Phone: 615-583-5151
  • Fax: 615-583-5154
Mailing address:
  • Phone: 615-583-5151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4728
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: