Timothy John Stephens

Primary specialty

Home Modifications ContractorTaxonomy code 171WH0202X

License

BC767187 Issued in MN

Practice address

22251 169TH St NW
Big Lake, MN 55309-8220

Phone

(612) 710-8451

NPI assigned

Nov 13, 2021

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1636761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636761600000",
    "number": "1053077024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22251 169TH ST NW",
            "city": "BIG LAKE",
            "state": "MN",
            "postal_code": "553098220",
            "telephone_number": "612-710-8451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22251 169TH ST NW",
            "city": "BIG LAKE",
            "state": "MN",
            "postal_code": "553098220",
            "telephone_number": "612-710-8451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STEPHENS",
        "first_name": "TIMOTHY",
        "middle_name": "JOHN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-11-13",
        "last_updated": "2021-11-13",
        "certification_date": "2021-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171WH0202X",
            "taxonomy_group": "",
            "desc": "Contractor, Home Modifications",
            "state": "MN",
            "license": "BC767187",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Seefeldt
• Gloria Simonson
• Christopher James Slice
• Gregory Thomas Smock, D.C.
• Southern General Contracting
• Nicole Rae Straw, MA OTR,L
• Barbro E Strom Langley
• Lola B Sutherland, MD
• The Gathering Assistant Living
• Sanjay Kumar Vanjarapu, DDS

• Home Modifications Contractor in Big Lake, MN
• Providers in Big Lake, MN by specialty
• Home Modifications Contractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.