Charles Nevin Stephenson, P.A.
Individual provider Active NPI Physician Assistant · Cisco, TX
NPI 1003984634 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1003984634
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA00390 (TX)
- Practice address
- 1619 Highway 206
Cisco, TX 76437-6447 - Phone
- (254) 442-1441
- Fax
- (254) 442-1466
- NPI assigned
- Dec 1, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Brownwood Specialty Group, PA | Past | Accepting new patients | |
| Cisco Medical Clinic, P.C. | Physician Assistant | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA00390 | TX | Yes |
Addresses
Primary practice location
1619 Highway 206
Cisco, TX 76437-6447
Mailing address
1619 Highway 206
Cisco, TX 76437-6447
Phone (254) 442-1441
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PA00390 | Other | TX | PA NUMBER |
Other providers in Cisco, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.