Provider Demographics
NPI:1992126379
Name:STEPHENSON, KARA NICOLE (CRNA)
Entity type:Individual
Prefix:MS
First Name:KARA
Middle Name:NICOLE
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:CB 8054
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-996-8685
Mailing Address - Fax:314-996-8479
Practice Address - Street 1:12634 OLIVE BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6337
Practice Address - Country:US
Practice Address - Phone:314-996-8685
Practice Address - Fax:314-996-8479
Is Sole Proprietor?:No
Enumeration Date:2014-01-02
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CRNA.0020325367500000X
MO2014000686367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered