MEDICARE: TORI SHAYE STEPHENS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	34609	TN
2	363L00000X	Nurse Practitioner	5019302	NC

General Provider Information

NPI Number	:	1043089626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TORI SHAYE STEPHENS

Provider Business Mailing Address
First Line	:	1500 1ST AVE N UNIT 3
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35203-1866
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4117 OLEANDER DR
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-6821
Country	:	US
Telephone Number	:	910-202-6988
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/25/2023
Last Update Date	:	01/11/2024

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Directions to “ TORI SHAYE STEPHENS ” Practice Location

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