Individual
KELLY MARIE STEPHENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, NP
Contact information
Practice address
2755 ALAMO ST STE 101, SIMI VALLEY, CA 93065-1311
(801) 361-7757
Mailing address
2755 ALAMO ST STE 101, SIMI VALLEY, CA 93065-1311
(801) 361-7757
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
711642
CA
363L00000X
Nurse Practitioner
Primary
19629
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1144543695
NPI
CA
Enumeration date
03/11/2010
Last updated
02/02/2011
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