Provider Demographics
NPI:1720753759
Name:STEPHENSON, KIRSTEN LEIGH (FNP-BC)
Entity type:Individual
Prefix:MISS
First Name:KIRSTEN
Middle Name:LEIGH
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 EVERLAND PKWY
Mailing Address - Street 2:
Mailing Address - City:ANGIER
Mailing Address - State:NC
Mailing Address - Zip Code:27501-9083
Mailing Address - Country:US
Mailing Address - Phone:919-320-3088
Mailing Address - Fax:
Practice Address - Street 1:4001 TUCKASEEGEE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-2831
Practice Address - Country:US
Practice Address - Phone:704-941-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-11
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCSTEP-EX3X8363LF0000X
NC5014897363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily