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NPI Code Detail

MEDICARE: STEPHANIE SUZANNE MACKLIN FNP

MEDICARE: STEPHANIE SUZANNE MACKLIN FNP
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
1363LF0000XFamily Nurse Practitioner769409TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1873N94OTHERTXBCBS TEXAS

General Provider Information

NPI Number : 1730454240
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE SUZANNE MACKLIN FNP
Provider Business Mailing Address
First Line : 1101 4TH AVE
Second Line :
City : CANYON
State : TX
Zip : 79015-3701
Country : US
Telephone Number : 806-655-7155
Fax Number : 806-655-7145
Provider Business Practice Location Address
First Line : 1101 4TH AVE
Second Line :
City : CANYON
State : TX
Zip : 79015-3701
Country : US
Telephone Number : 806-655-7155
Fax Number : 806-655-7145
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2012
Last Update Date : 01/12/2015

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