=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578483798
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHANIE L DEWALT APRN, FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2026
-----------------------------------------------------
Last Update Date | 07/17/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 521 HIGHWAY 51 N
-----------------------------------------------------
City | RIPLEY
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38063-5903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 731-635-7000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 456
-----------------------------------------------------
City | GATES
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38037-0456
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 731-413-0167
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 41594
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------