MRS. STEPHANIE B. PEMBERTON (NPI# 1205287513) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205287513 |
| Entity Type | Individual |
| Full Name | MRS. STEPHANIE B. PEMBERTON |
| Credential | PMHNP-BC |
| Practice Address |
3600 N Prow Rd Bloomington IN 47404-1616 |
| Practice Telephone | 8123318000 |
| Practice Fax Number | 8129612478 |
| Mailing Telephone | 8123318000 |
| Mailing Fax Number | 8129612478 |
| Enumeration Date | 2016-06-28 |
| Last Update Date | 2016-06-28 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
28174681A | IN | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
3600 N PROW RD |
| City | BLOOMINGTON |
| State | IN |
| Zip Code | 47404-1616 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891796108 | Bloomington Meadows Gp | Psychiatric Hospital | 3600 N Prow Rd, Bloomington, IN 47404-1616 | 2005-08-09 |
| 1558970517 | Randy Bargo | Nurse Practitioner | 3600 N Prow Rd, Bloomington, IN 47404-1616 | 2020-07-27 |
| 1396215786 | Hui Shi Serena Loh | Nurse Practitioner | 3600 N Prow Rd, Bloomington, IN 47404-1616 | 2018-11-28 |
| 1124465729 | Ronda Rene Bray | Nurse Practitioner | 3600 N Prow Rd, Bloomington, IN 47404-1616 | 2013-05-23 |
| 1760555049 | Jennifer Bartlett Lorinsky-simpson | Counselor | 3600 N Prow Rd, Bloomington, IN 47404-1616 | 2006-11-16 |
| 1033298120 | Bloomington Meadows Gp | Clinical Nurse Specialist | 3600 N Prow Rd, Bloomington, IN 47404-1616 | 2006-11-02 |
| 1417968595 | Bloomington Meadows Gp - | Psychiatric Residential Treatment Facility | 3600 N Prow Rd, Bloomington, IN 47404-1616 | 2006-08-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013526631 | Sandra Clark | Counselor | 205 N College Avenue, Suite 210a, Bloomington, IN 47404 | 2020-07-29 |
| 1750926085 | Michelle Christine Dustin | Nurse Practitioner | 610 N Morton Street, Bloomigton, IN 47404 | 2019-11-11 |
| 1316440191 | Julie D'argent | Psychologist | 205 N College Ave Ste 430, Bloomington, IN 47404 | 2018-03-17 |
| 1770966467 | Richard Lawson | Counselor | 1117 North Jackson Street, Bloomington, IN 47404 | 2015-06-30 |
| 1477952109 | Teresa R. Foster | Social Worker | 205 N. College Avenue, Suite 210b, Bloomington, IN 47404 | 2014-08-19 |
| 1073879532 | First Health Plus, Inc | Clinic/Center | 104 North Curry Pike, Bloomington, IN 47404 | 2012-04-09 |
| 1497079982 | Tera Dee Nance | Counselor | 101 W. Kirkwood Avenue, Suite 009 Fountain Square Mall, Bloomington, IN 47404 | 2010-03-26 |
| 1962643114 | Pathways Counseling Center | Community/Behavioral Health | 3866 W. Third Street, Bloomington, IN 47404 | 2009-03-18 |
| 1932358595 | Catherine Elizabeth Batka | Psychologist | 101 W. Kirkwood Ave, Suite 103, Bloomington, IN 47404 | 2008-09-18 |
| 1396901005 | Kijin Woo | Dentist | 330 N Jacob Drive, Bloomington, IN 47404 | 2008-08-01 |
| Find all providers in zip 47404 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134780851 | Eric Lyakhovetsky | Nurse Practitioner | 327 W Saidah Rd, Bloomington, IN 47404-8965 | 2019-06-24 |
| 1477822344 | Wenjing Cao | Nurse Practitioner | 108 W. Market, Bloomington, IL 61701 | 2011-12-22 |
| 1679684203 | Colleen S Odonnell | Nurse Practitioner | 1603 W Old Shakopee Rd, Bloomington, MN 55431-3065 | 2006-08-31 |
| 1558970517 | Randy Bargo | Nurse Practitioner | 3600 N Prow Rd, Bloomington, IN 47404-1616 | 2020-07-27 |
| 1750921870 | Lotus Integrated Care, LLC | Nurse Practitioner | 654 S Walker St, Bloomington, IN 47403-2159 | 2020-01-07 |
| 1033768569 | Amanda Lavender | Nurse Practitioner | 727 W 2nd St, Bloomington, IN 47403-2209 | 2019-09-07 |
| 1396215786 | Hui Shi Serena Loh | Nurse Practitioner | 3600 N Prow Rd, Bloomington, IN 47404-1616 | 2018-11-28 |
| 1922583285 | Bettina Ervin-rodgers | Nurse Practitioner | 108 W Market St, Bloomington, IL 61701-3918 | 2018-10-02 |
| 1710479753 | Kevin Nelson Moore | Nurse Practitioner | 550 S Adams St, Bloomington, IN 47403 | 2018-06-05 |
| 1578942348 | Brandee Kay Marksberry | Nurse Practitioner | 445 S Landmark Ave, Bloomington, IN 47403-5004 | 2015-05-26 |
| Find all providers in BLOOMINGTON | ||||
| City | BLOOMINGTON |
| Zip Code | 47404 |
Please comment or provide details below to improve the information on MRS. STEPHANIE B. PEMBERTON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.