Healthcare Provider Details

I. General information

NPI: 1215207428
Provider Name (Legal Business Name): MALIA LINDA STEPHENSON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2012
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12222 N CENTRAL EXPY STE 340
DALLAS TX
75243-3755
US

IV. Provider business mailing address

1540 KELLER PKWY STE 108-429
KELLER TX
76248-3686
US

V. Phone/Fax

Practice location:
  • Phone: 972-972-4851
  • Fax: 972-556-5202
Mailing address:
  • Phone: 972-771-2011
  • Fax: 877-292-3457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number104379
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number828628
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: