Provider Demographics
NPI:1689149239
Name:RUSSELL, STEPHEN KEN (FNP-BC)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:KEN
Last Name:RUSSELL
Suffix:
Gender:
Credentials:FNP-BC
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Other - Credentials:
Mailing Address - Street 1:ATTN: CPT STEPHEN RUSSELL
Mailing Address - Street 2:5005 NORTH PIEDRAS STREET
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79920
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BRIAN D. ALLGOOD ARMY COMMUNITY HOSP
Practice Address - Street 2:OPC 371 BOX 39
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96271-9001
Practice Address - Country:US
Practice Address - Phone:315-737-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY34366.1665363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily