Healthcare Provider Details

I. General information

NPI: 1396148920
Provider Name (Legal Business Name): STEPHANIE LYNNE HUNT NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2014
Last Update Date: 09/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 S CENTRAL ST
HALLSVILLE TX
75650-6202
US

IV. Provider business mailing address

2010 BILL OWENS PKWY
LONGVIEW TX
75604-6210
US

V. Phone/Fax

Practice location:
  • Phone: 903-668-3400
  • Fax:
Mailing address:
  • Phone: 903-247-3400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP126469
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: