Healthcare Provider Details

I. General information

NPI: 1053719310
Provider Name (Legal Business Name): STACY LYNN TURNER APRN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2014
Last Update Date: 05/19/2022
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 HIGHWAY 3444
ANNVILLE KY
40402-8245
US

IV. Provider business mailing address

78 HIGHWAY 3444 STE 1
ANNVILLE KY
40402-8245
US

V. Phone/Fax

Practice location:
  • Phone: 606-364-5162
  • Fax: 606-364-3920
Mailing address:
  • Phone: 859-623-5500
  • Fax: 859-625-5007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1105492
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3009118
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3009118
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: