Healthcare Provider Details

I. General information

NPI: 1265066468
Provider Name (Legal Business Name): STEVAN CUELLAR NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2020
Last Update Date: 02/26/2020
Certification Date: 02/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 W MAIN ST STE 115
ALLEN TX
75013-8057
US

IV. Provider business mailing address

1060 FM 983
FERRIS TX
75125-9117
US

V. Phone/Fax

Practice location:
  • Phone: 214-491-4191
  • Fax: 469-519-0407
Mailing address:
  • Phone: 972-978-0627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP141177
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: