Provider Demographics
NPI:1871093823
Name:STEAHLY, MOLLY
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:STEAHLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 FM 2488
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76636-4562
Mailing Address - Country:US
Mailing Address - Phone:719-494-6185
Mailing Address - Fax:
Practice Address - Street 1:153 FM 2488
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:TX
Practice Address - Zip Code:76636-4562
Practice Address - Country:US
Practice Address - Phone:719-494-6185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX902382163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health