Provider Demographics
NPI:1306975909
Name:STEPHENS, COLLEEN KATHLEEN (MSN, APRN, AGNP,GNP)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:KATHLEEN
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:MSN, APRN, AGNP,GNP
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:
Other - Last Name:STEPHENS-KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, APRN, AGNP,GNP
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:254-724-8800
Mailing Address - Fax:
Practice Address - Street 1:6901 MEDICAL PKWY
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-7910
Practice Address - Country:US
Practice Address - Phone:254-751-4242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX257249363LG0600X
TXAP115002363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX185280801Medicaid
TX8L11092Medicare PIN
TX8J4743Medicare PIN