Healthcare Provider Details

I. General information

NPI: 1942829155
Provider Name (Legal Business Name): VPA OF TEXAS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2020
Last Update Date: 10/21/2022
Certification Date: 10/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4545 FULLER DR STE 325
IRVING TX
75038-6530
US

IV. Provider business mailing address

PO BOX 639295 DEPT 93386
CINCINNATI OH
45263-9295
US

V. Phone/Fax

Practice location:
  • Phone: 972-870-5511
  • Fax: 972-870-5512
Mailing address:
  • Phone: 972-870-5511
  • Fax: 972-870-5512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY STEVENS
Title or Position: OWNER
Credential: DO
Phone: 248-824-6600