Basic Information
| Provider Information | |||||||||
| NPI: | 1154385136 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEPHENS | ||||||||
| FirstName: | GRETCHEN | ||||||||
| MiddleName: | KAY | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 930 FRANKLIN ST SE | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358014312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565394080 | ||||||||
| FaxNumber: | 2565394099 | ||||||||
| Practice Location | |||||||||
| Address1: | 930 FRANKLIN ST SE | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358014312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565394080 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2006 | ||||||||
| LastUpdateDate: | 10/02/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | 1-083464 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
ID Information
| ID | Type | State | Issuer | Description | 113592 | 05 | AL | MEDICAID | 113591 | 05 | AL | MEDICAID | 515-98703 | 01 | AL | BCBS | OTHER | 113595 | 05 | AL | MEDICAID | 510-49327 | 01 | AL | BCBS | OTHER | 510-49329 | 01 | AL | BCBS | OTHER | 009935907 | 05 | AL | MEDICAID | 113593 | 05 | AL | MEDICAID | 515-33535 | 01 | AL | BCBS | OTHER | 113594 | 05 | AL | MEDICAID | 510-49328 | 01 | AL | BCBS | OTHER | 515-98702 | 01 | AL | BCBS | OTHER |