Healthcare Provider Details

I. General information

NPI: 1578483798
Provider Name (Legal Business Name): STEPHANIE L DEWALT APRN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 HIGHWAY 51 N
RIPLEY TN
38063-5903
US

IV. Provider business mailing address

PO BOX 456
GATES TN
38037-0456
US

V. Phone/Fax

Practice location:
  • Phone: 731-635-7000
  • Fax:
Mailing address:
  • Phone: 731-413-0167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number41594
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: