Provider Demographics
NPI:1487438529
Name:STEPHENS, MATHEW W (FNP-C)
Entity type:Individual
Prefix:
First Name:MATHEW
Middle Name:W
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3675 WASATCH DR
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-2968
Mailing Address - Country:US
Mailing Address - Phone:219-929-7610
Mailing Address - Fax:
Practice Address - Street 1:1920 CALIFORNIA ST STE A
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1953
Practice Address - Country:US
Practice Address - Phone:530-247-7070
Practice Address - Fax:530-247-7246
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95026509363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily