Provider Demographics
NPI:1235651779
Name:SISSON, STEPHANIE DANIELLE (NP-C)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:DANIELLE
Last Name:SISSON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 E 2ND AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-3223
Mailing Address - Country:US
Mailing Address - Phone:706-692-9768
Mailing Address - Fax:
Practice Address - Street 1:415 E 2ND AVE STE 100
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-3223
Practice Address - Country:US
Practice Address - Phone:706-692-9768
Practice Address - Fax:706-692-4040
Is Sole Proprietor?:No
Enumeration Date:2017-07-15
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN230763363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily