Provider Demographics
NPI:1336548288
Name:MAYTON, STEPHANIE K (NP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:K
Last Name:MAYTON
Suffix:
Gender:F
Credentials:NP
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Other - Credentials:
Mailing Address - Street 1:445 CHARLES H DIMMOCK PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-2970
Mailing Address - Country:US
Mailing Address - Phone:804-520-1764
Mailing Address - Fax:866-781-3220
Practice Address - Street 1:445 CHARLES H DIMMOCK PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-2970
Practice Address - Country:US
Practice Address - Phone:804-520-1764
Practice Address - Fax:866-781-3220
Is Sole Proprietor?:No
Enumeration Date:2014-08-16
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024171922363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVVF092AMedicare PIN