Provider Demographics
NPI:1528329612
Name:STEPHENS, KERRI ANN (FNP)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:ANN
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2331 PROGRESS ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661-9384
Mailing Address - Country:US
Mailing Address - Phone:989-345-1184
Mailing Address - Fax:989-345-6944
Practice Address - Street 1:2331 PROGRESS ST
Practice Address - Street 2:SUITE D
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-9384
Practice Address - Country:US
Practice Address - Phone:989-345-1184
Practice Address - Fax:989-345-6944
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704240636363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704240636OtherRN & FNP LICENSE