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NPI Code Detail

MEDICARE: STEPHANIE DENNISON

MEDICARE: STEPHANIE DENNISON
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
1363L00000XNurse Practitioner239278LA
2363LF0000XFamily Nurse Practitioner0995641CO
3363LF0000XFamily Nurse Practitioner239278LA

General Provider Information

NPI Number : 1760092282
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE DENNISON
Provider Business Mailing Address
First Line : 1666 E BERT KOUNS INDUSTRIAL LOOP STE 105
Second Line :
City : SHREVEPORT
State : LA
Zip : 71105-5718
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1666 E BERT KOUNS INDUSTRIAL LOOP STE 105
Second Line :
City : SHREVEPORT
State : LA
Zip : 71105-5718
Country : US
Telephone Number : 318-212-3520
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2020
Last Update Date : 12/31/2025

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Directions to “ STEPHANIE DENNISON ” Practice Location

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