Provider Demographics
NPI:1174389266
Name:STEVENSON, KARRIE LEA (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:KARRIE
Middle Name:LEA
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10415 INDIAN TRL
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:TX
Mailing Address - Zip Code:76266-6208
Mailing Address - Country:US
Mailing Address - Phone:940-367-8257
Mailing Address - Fax:
Practice Address - Street 1:10415 INDIAN TRL
Practice Address - Street 2:
Practice Address - City:SANGER
Practice Address - State:TX
Practice Address - Zip Code:76266-6208
Practice Address - Country:US
Practice Address - Phone:940-367-8257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX678698163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant