Provider Demographics
NPI:1154385136
Name:STEPHENS, GRETCHEN KAY (CRNP)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:KAY
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 FRANKLIN ST SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4312
Mailing Address - Country:US
Mailing Address - Phone:256-539-4080
Mailing Address - Fax:256-539-4099
Practice Address - Street 1:930 FRANKLIN ST SE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4312
Practice Address - Country:US
Practice Address - Phone:256-539-4080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-083464363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL113592Medicaid
AL113591Medicaid
AL515-98703OtherBCBS
AL113595Medicaid
AL510-49327OtherBCBS
AL510-49329OtherBCBS
AL009935907Medicaid
AL113593Medicaid
AL515-33535OtherBCBS
AL113594Medicaid
AL510-49328OtherBCBS
AL515-98702OtherBCBS
AL113591Medicaid
AL515-98702OtherBCBS
AL113594Medicaid