Healthcare Provider Details

I. General information

NPI: 1811916786
Provider Name (Legal Business Name): JEFF STEPHENS NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MR. JEFF M STEPHENS

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5234 AIRPORT RD NW # 200
ROANOKE VA
24012-1603
US

IV. Provider business mailing address

5234 AIRPORT RD NW # 200
ROANOKE VA
24012-1603
US

V. Phone/Fax

Practice location:
  • Phone: 540-563-8000
  • Fax:
Mailing address:
  • Phone: 540-563-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2279E0002X
TaxonomyEmergency Care Registered Respiratory Therapist
License Number25831
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024177544
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: