Individual
STEPHANIE MENGES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPAS, PA-C
Contact information
Practice address
650 JOEL DR, FORT CAMPBELL, KY 42223-5318
(270) 798-8400
Mailing address
4225 LYLEWOOD RD, INDIAN MOUND, TN 37079-9443
(401) 369-0112
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1083267603
—
TN
Enumeration date
07/23/2019
Last updated
07/17/2024
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