Basic Information
| Provider Information | |||||||||
| NPI: | 1902018518 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEVENS | ||||||||
| FirstName: | CHRISTY | ||||||||
| MiddleName: | DAWN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 480 GALLETTI WAY | ||||||||
| Address2: | |||||||||
| City: | SPARKS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 894315564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7756882078 | ||||||||
| FaxNumber: | 7756883306 | ||||||||
| Practice Location | |||||||||
| Address1: | 480 GALLETTI WAY | ||||||||
| Address2: | |||||||||
| City: | SPARKS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 894315564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7756882078 | ||||||||
| FaxNumber: | 7756883306 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2007 | ||||||||
| LastUpdateDate: | 09/30/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | RN32798 | NV | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health | 363LF0000X | APN00522 | NV | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LP0808X | APRN00522 | NV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 002410009 | 05 | NV | MEDICAID |