Provider Demographics
NPI:1104046598
Name:KNOWLES, STEPHANIE (APRN-BC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:KNOWLES
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:LYNN
Other - Last Name:MERRILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-C
Mailing Address - Street 1:5500 FRISCO SQUARE BLVD
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-3305
Mailing Address - Country:US
Mailing Address - Phone:469-430-7836
Mailing Address - Fax:
Practice Address - Street 1:5500 FRISCO SQUARE BLVD
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-3305
Practice Address - Country:US
Practice Address - Phone:469-430-7836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX722811363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX839N60OtherBLUECROSS
TX284693302Medicaid
TX284693301Medicaid
TX839N60OtherBLUECROSS
TXTXB134510Medicare PIN