1669451522 NPI number — DR. JENNIFER BOYER STEVENS PSYD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669451522 NPI number — DR. JENNIFER BOYER STEVENS PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEVENS
Provider First Name:
JENNIFER
Provider Middle Name:
BOYER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSYD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STEVENS
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
BOYER
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PSY.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1669451522
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 925
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OSAGE BEACH
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65065-0925
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-480-7910
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1191 HWY KK
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
OSAGE BEACH
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65065
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-480-7910
Provider Business Practice Location Address Fax Number:
573-302-7239
Provider Enumeration Date:
01/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  2004013642 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 103T00000X , with the licence number: 2004013642 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)





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