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NPI Code Detail

MEDICARE: DR. KENNETH A STEPHENSON MD

MEDICARE:  DR. KENNETH A STEPHENSON  MD
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
1174400000XSpecialistJ0871TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1245234871
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KENNETH A STEPHENSON MD
Provider Business Mailing Address
First Line : 301 UTICA AVE
Second Line :
City : LUBBOCK
State : TX
Zip : 79416-3111
Country : US
Telephone Number : 806-797-4985
Fax Number : 806-792-8588
Provider Business Practice Location Address
First Line : 301 UTICA AVE
Second Line :
City : LUBBOCK
State : TX
Zip : 79416-3111
Country : US
Telephone Number : 806-797-4985
Fax Number : 806-792-8588
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2005
Last Update Date : 02/10/2022

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Directions to “ DR. KENNETH A STEPHENSON MD” Practice Location

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