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General NPI Number Information
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NPI Number | 1245048305
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Entity Type | Individual
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Provider Name | STEPHANIE SELF
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Gender | Female
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Dates
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Enumeration Date | 12/20/2024
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 206 N MURCHISON ST
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City | ATHENS
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State | TX
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Zip | 75751-2132
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Country | US
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Telephone | 940-366-5581
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Fax |
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Provider Business Mailing Address
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Address Line | 524 AUTRY WAY
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City | MABANK
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State | TX
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Zip | 75147-2364
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Country | US
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Telephone |
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1183210
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License Number State | TX
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