Basic Information
| Provider Information | |||||||||
| NPI: | 1265562102 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEPHENS | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | M | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2400 CEDAR BEND DR | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787585378 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5129014031 | ||||||||
| FaxNumber: | 5129013937 | ||||||||
| Practice Location | |||||||||
| Address1: | 2400 CEDAR BEND DR | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787585378 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5129014031 | ||||||||
| FaxNumber: | 5129013936 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2007 | ||||||||
| LastUpdateDate: | 07/20/2016 | ||||||||
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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 | 363L00000X | 101901 | CO | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LP0200X | AP106078 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 015908 | 01 | KAISER-COMMERCIAL NUMBER | OTHER |