=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265029607
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTOPHER STEPHENS APRN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/30/2020
-----------------------------------------------------
Last Update Date | 11/17/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2117 S 7TH ST
-----------------------------------------------------
City | IRONTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45638-2538
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-533-9922
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 112 ALTAWOOD RD
-----------------------------------------------------
City | RACELAND
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41169-9001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-922-9855
-----------------------------------------------------
Fax | 606-203-8313
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | APRN.CNP.0028229
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------