Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Clyde Richard Stephens, PAC

Individual provider Physician Assistant · NPI 1114964780

Clyde Richard Stephens, PAC is a Physician Assistant in Roseau, Minnesota. Qualified in 2000, 26 years ago. Practices with Lakewood Health Center, an 11-clinician group and accepts Medicare assignment. Licensed in Minnesota.

Years since qualifying
26
Licensed in
MN
In the registry since
2006
What do these letters mean?
PAC — Physician Assistant, Certified
A physician assistant holding current national certification; usually written PA-C.

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Practice location Address checks out

711 Delmore Dr
Roseau, MN 56751-1534
Phone: (218) 463-1365
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 9532 (MN)

Record details

NPI number1114964780
Entity typeIndividual (Type 1)
GenderMale
Credentials PAC
Sole proprietorNo
NPI enumeratedJune 1, 2006
Last updated in NPPESJuly 13, 2026
Mailing address235 Old Highway 11 E, Greenbush, MN 56726-4128

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2000 (26 years in practice)
Group practice Lakewood Health Center — 11 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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