Healthcare Provider Details

I. General information

NPI: 1790091080
Provider Name (Legal Business Name): JEAN STODGHILL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2010
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1143 FAIRWAY STREET SUITE 103
BOWLING GREEN KY
42103
US

IV. Provider business mailing address

1143 FAIRWAY STREET SUITE 103
BOWLING GREEN KY
42103
US

V. Phone/Fax

Practice location:
  • Phone: 812-901-6881
  • Fax: 812-285-8392
Mailing address:
  • Phone: 812-901-6881
  • Fax: 812-285-8392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3006552
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3006552
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: