Provider Demographics
NPI:1467823179
Name:MCKITHAN, STEPHANIE BOURNE (FNP-C, APRN, DNP)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:BOURNE
Last Name:MCKITHAN
Suffix:
Gender:F
Credentials:FNP-C, APRN, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6650 RAMSEY ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-9318
Mailing Address - Country:US
Mailing Address - Phone:910-630-5203
Mailing Address - Fax:
Practice Address - Street 1:6650 RAMSEY ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28311-9318
Practice Address - Country:US
Practice Address - Phone:910-630-5203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-08
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5008220363LX0106X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily