Provider Demographics
NPI:1831590769
Name:STEPHENS, LISA A (PA-C)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:778 E 700 S
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84015-1204
Mailing Address - Country:US
Mailing Address - Phone:385-370-6716
Mailing Address - Fax:866-493-3228
Practice Address - Street 1:778 E 700 S
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-1204
Practice Address - Country:US
Practice Address - Phone:385-370-6716
Practice Address - Fax:866-493-3228
Is Sole Proprietor?:No
Enumeration Date:2014-09-10
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4931658-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU000091248Medicare PIN