Provider Demographics
NPI:1891972659
Name:HOLLEN CALLESTO, STEPHANIE (FNP/FA)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:
Last Name:HOLLEN CALLESTO
Suffix:
Gender:F
Credentials:FNP/FA
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:LYNETTE
Other - Last Name:GUTIERREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RNFA
Mailing Address - Street 1:5881 BISCAMP RD
Mailing Address - Street 2:
Mailing Address - City:SILSBEE
Mailing Address - State:TX
Mailing Address - Zip Code:77656-6942
Mailing Address - Country:US
Mailing Address - Phone:409-381-9078
Mailing Address - Fax:
Practice Address - Street 1:5881 BISCAMP RD
Practice Address - Street 2:
Practice Address - City:SILSBEE
Practice Address - State:TX
Practice Address - Zip Code:77656-6942
Practice Address - Country:US
Practice Address - Phone:409-381-9078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX670056163WR0006X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB163139Medicare PIN
TXTXB164592Medicare PIN
TXTXB164574Medicare PIN
TXTXB164567Medicare PIN