Individual
CHARLES NEVIN STEPHENSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
1619 HIGHWAY 206, CISCO, TX 76437-6447
(254) 442-1441
(254) 442-1466
Mailing address
1619 HIGHWAY 206, CISCO, TX 76437-6447
(254) 442-1441
(254) 442-1466
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00390
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA00390
PA NUMBER
TX
Enumeration date
12/01/2006
Last updated
07/08/2007
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