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General NPI Number Information
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NPI Number | 1104471978
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Entity Type | Individual
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Provider Name | STEPHANIE ANN FOUTS CRNP
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Gender | Female
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Dates
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Enumeration Date | 08/07/2019
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Last Update Date | 10/27/2021
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Provider Practice Location Address
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Address Line | 6701 AIRPORT BLVD. B BLDG., T LEVEL
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City | MOBILE
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State | AL
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Zip | 36608-3764
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Country | US
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Telephone | 251-625-6896
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Fax | 251-266-3209
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Provider Business Mailing Address
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Address Line | 29653 ANCHOR CROSS BLVD
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City | DAPHNE
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State | AL
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Zip | 36526-9594
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Country | US
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Telephone | 251-625-6896
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Fax | 251-625-6897
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 1-134721
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License Number State | AL
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