Healthcare Provider Details

I. General information

NPI: 1821715509
Provider Name (Legal Business Name): SHANTELLE ALICIA STEPHENS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANTELLE ALICIA HILL

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 S ZINTEL WAY STE 110
KENNEWICK WA
99337-5092
US

IV. Provider business mailing address

550 GAGE BLVD STE 101
RICHLAND WA
99352-9532
US

V. Phone/Fax

Practice location:
  • Phone: 509-942-3125
  • Fax: 509-585-8173
Mailing address:
  • Phone: 509-473-0637
  • Fax: 509-627-2983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN60850819
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP61538886
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: