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Individual

MR. CHARLES RANDALL STEPHENS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRNP

Contact information

Practice address
1190 MAIN STREET, SUMITON, AL 35148
(205) 648-2660
Mailing address
129 LOCKERBIE LN, DORA, AL 35062-4466
(205) 901-8850

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
1-072559
AL
363LF0000X
Family Nurse Practitioner
R0082474
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
9772559
OK
Enumeration date
07/18/2005
Last updated
07/08/2007
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