MEDICARE: TENIKA ROCONDRA STEVENSON

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	171W00000X	Contractor		AL

General Provider Information

NPI Number	:	1942141957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TENIKA ROCONDRA STEVENSON

Provider Business Mailing Address
First Line	:	94 LEE WILLIAMS RD
Second Line	:
City	:	MARION
State	:	AL
Zip	:	36756-6073
Country	:	US
Telephone Number	:	877-668-0565
Fax Number	:

Provider Business Practice Location Address
First Line	:	94 LEE WILLIAMS RD
Second Line	:
City	:	MARION
State	:	AL
Zip	:	36756-6073
Country	:	US
Telephone Number	:	205-526-9720
Fax Number	:

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

Provider Enumeration Date	:	04/03/2026
Last Update Date	:	04/03/2026

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