STEPHANIE R REVORD APRN NPI 1174992846

NPI Information

  • NPI: 1174992846
  • Provider Name: STEPHANIE R REVORD, APRN
  • Classification: Nurse Practitioner - 363L00000X
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 201 RIDGE ST STE 312
    COUNCIL BLUFFS, IA
    ZIP 51503
  • Phone: (712) 396-7880

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NPI Details

Stephanie R Revord, APRN is a nurse practitioner in Council Bluffs, IA with 11 years of experience. The provider is (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. Stephanie R Revord, APRN NPI is 1174992846. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

Education
Medical School: UNIVERSITY OF NEBRASKA COLLEGE OF MEDICINE
Graduation Year:2015

The provider's business location address is:

201 RIDGE ST STE 312
COUNCIL BLUFFS, IA
ZIP 51503-643
Phone: (712) 396-7880
Fax: (712) 396-7885

The NPI 1174992846 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 9/23/2015 and was last updated on 7/3/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LW0102XNurse PractitionerWomen's HealthF141666IOWANo
2363L00000XNurse PractitionerF141666IOWAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
110026480117MEDICAIDNEBRASKA
210026211300MEDICAIDNEBRASKA
31174992846MEDICAIDIOWA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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