Healthcare Provider Details

I. General information

NPI: 1235988635
Provider Name (Legal Business Name): VALERIE RENEE STEPHENS RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2024
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 MARRIOTT DR
NASHVILLE TN
37214-5048
US

IV. Provider business mailing address

2046 SHAYLIN LOOP
ANTIOCH TN
37013-8406
US

V. Phone/Fax

Practice location:
  • Phone: 615-585-9659
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number6573
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: