Organization
JACKIE D. STEVENS
Active
Other names
Psychiatric Med Management
Organization subpart
No
Provider details
NPI number
Authorized official
JACKIE DEE STEVENS (AUTHORIZED OFFICIAL)
(507) 288-6978
Entity
Organization
Contact information
Practice address
59516 390TH AVE, ZUMBRO FALLS, MN 55991-5161
(507) 398-9086
Mailing address
59516 390TH AVE, ZUMBRO FALLS, MN 55991-5161
(507) 398-9086
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
03/06/2023
Last updated
07/18/2023
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