Provider Demographics
NPI:1427879808
Name:STEPHENSON, CHASE POWELL (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:CHASE
Middle Name:POWELL
Last Name:STEPHENSON
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2103 GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-3563
Mailing Address - Country:US
Mailing Address - Phone:318-715-4230
Mailing Address - Fax:
Practice Address - Street 1:2103 GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-3563
Practice Address - Country:US
Practice Address - Phone:318-715-4230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1177250363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health