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General NPI Number Information
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NPI Number | 1821715509
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Entity Type | Individual
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Provider Name | SHANTELLE ALICIA STEPHENS ARNP
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Gender | Female
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Dates
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Enumeration Date | 10/24/2022
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Last Update Date | 10/30/2024
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Provider Practice Location Address
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Address Line | 3900 S ZINTEL WAY STE 110
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City | KENNEWICK
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State | WA
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Zip | 99337-5092
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Country | US
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Telephone | 509-942-3125
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Fax | 509-585-8173
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Provider Business Mailing Address
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Address Line | 550 GAGE BLVD STE 101
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City | RICHLAND
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State | WA
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Zip | 99352-9532
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Country | US
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Telephone | 509-473-0637
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Fax | 509-627-2983
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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 | 163WP0200X
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Taxonomy Name | Pediatric Registered Nurse
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License Number | RN60850819
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | AP61538886
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License Number State | WA
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