MEDICARE: MRS. KATHLEEN MARIE STEVENS ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	2403P	KY
2	367A00000X	Advanced Practice Midwife	2403M	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912991969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHLEEN MARIE STEVENS ARNP

Provider Business Mailing Address
First Line	:	545 LEVI BEAMS RD
Second Line	:
City	:	MAGNOLIA
State	:	KY
Zip	:	42757-7960
Country	:	US
Telephone Number	:	270-324-3085
Fax Number	:

Provider Business Practice Location Address
First Line	:	289 IRELAND AVE.
Second Line	:	BUILDING 851
City	:	FORT KNOX
State	:	KY
Zip	:	40121-5111
Country	:	US
Telephone Number	:	502-624-4031
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2005
Last Update Date	:	10/29/2014

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