Individual provider Active NPI

Danielle Street Stephens, D.O.

  • Pediatrics Physician
  • Kingsport, TN
National Provider Identifier
1962846519
Registry record updated Feb 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
DO02949 Issued in TN
Practice address
105 W Stone Dr Ste 2a
Kingsport, TN 37660-3365
Phone
(423) 857-2066
NPI assigned
Apr 25, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X R3339 KY
Student in an Organized Health Care Education/Training Program 390200000X
Pediatrics Physician 208000000X DO02949 TN Primary

Addresses

Primary practice location

105 W Stone Dr Ste 2a
Kingsport, TN 37660-3365

Mailing address

PO Box 9
Kingsport, TN 37662-0009
Phone (423) 857-2066

Other practice location 1

800 Rose St
MN 118
Lexington, KY 40536-0001
Phone (859) 323-5197

Other names 1

  • Danielle Street Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160819000637 TN Practitioner - Pediatric Medicine 3779898390 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
Lincoln Memorial University Medical Department, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Holston Medical Group PCGroup PAC ID 8224935754, 239 clinicians

Practice addresses (Care Compare)

105 W Stone Dr
Kingsport, TN 37660-3256

322 Steeles Rd
Bristol, TN 37620-9532
Phone (423) 217-1360

350 Steeles Rd
Unit 1
Bristol, TN 37620-9532
Phone (423) 844-4925

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
DO02949TNMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Holston Medical Group PC Pediatrics CurrentSince Aug 5, 2016 Accepting new patients

Locations

350 Steeles Rd
#1
Bristol, TN 37620
Phone (423) 844-4925

105 W Stone Dr
Ste 2A
Kingsport, TN 37660
Phone (423) 224-3375

2204 Pavilion Dr
Ste 200
Kingsport, TN 37660
Phone (423) 224-3900

Interoperability endpoints

  • Direct secure messaging: daniellestreet@hmgpath.allscriptsdirect.net

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1366848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613433600000",
    "number": "1962846519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376620009",
            "telephone_number": "423-857-2066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 W STONE DR STE 2A",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376603365",
            "telephone_number": "423-857-2066"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "800 Rose St",
            "address_2": "MN 118",
            "address_purpose": "LOCATION",
            "city": "Lexington",
            "state": "KY",
            "postal_code": "405360001",
            "country_code": "US",
            "telephone_number": "859-323-5197",
            "fax_number": "859-323-1214",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STEPHENS",
        "first_name": "DANIELLE",
        "middle_name": "STREET",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-25",
        "last_updated": "2021-02-16",
        "certification_date": "2021-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "KY",
            "license": "R3339",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TN",
            "license": "DO02949",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DANIELLE",
            "last_name": "STREET",
            "credential": "DO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Kingsport, TN

Sources for this page

Verify at the official NPI Registry.