Provider Demographics
NPI:1003790387
Name:MCCALLISTER, STEPHANIE DEANNA (CNP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:DEANNA
Last Name:MCCALLISTER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:DEANNA
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:412 LILYFIELD LN
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:OH
Mailing Address - Zip Code:43119-8037
Mailing Address - Country:US
Mailing Address - Phone:614-323-1989
Mailing Address - Fax:
Practice Address - Street 1:412 LILYFIELD LN
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:OH
Practice Address - Zip Code:43119-8037
Practice Address - Country:US
Practice Address - Phone:614-323-1989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-01
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH409135163W00000X
OH0039902363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse