Basic Information
| Provider Information | |||||||||
| NPI: | 1205081478 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STEPPING STONES PEDIATRICS, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10941 RAVEN RIDGE RD | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276146487 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192350543 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10941 RAVEN RIDGE RD | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276146487 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192350543 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2008 | ||||||||
| LastUpdateDate: | 12/01/2008 | ||||||||
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| AuthorizedOfficialLastName: | BURKE-HAYNES | ||||||||
| AuthorizedOfficialFirstName: | KAREN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9192350543 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | 9300662 | NC | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
ID Information
| ID | Type | State | Issuer | Description | 89013ET | 05 | NC | MEDICAID |