MEDICARE: STEPHANIE FENTER L.AC., DIPL.AC.

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	171100000X	Acupuncturist	00010	MS
2	171100000X	Acupuncturist	152722
3	171100000X	Acupuncturist	14671

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14671	OTHER	CA	CA STATE ACUPUNCTURE LICENSE
2	152722	OTHER		NCCAOM CERTIFICATION
3	00010	OTHER		MS ACUPUNCTURE LICENSE

General Provider Information

NPI Number	:	1700129723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE FENTER L.AC., DIPL.AC.

Provider Business Mailing Address
First Line	:	149 N CENTRAL AVE
Second Line	:
City	:	RIDGELAND
State	:	MS
Zip	:	39157-2334
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1050 MARINA VILLAGE PKWY STE 104
Second Line	:
City	:	ALAMEDA
State	:	CA
Zip	:	94501-1033
Country	:	US
Telephone Number	:	510-603-0915
Fax Number	:

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

Provider Enumeration Date	:	03/27/2013
Last Update Date	:	05/13/2025

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Directions to “ STEPHANIE FENTER L.AC., DIPL.AC.” Practice Location

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