Healthcare Provider Details

I. General information

NPI: 1093456477
Provider Name (Legal Business Name): STEPHANIE A HART
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2022
Last Update Date: 04/07/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5925 LOUISVILLE RD
BOWLING GREEN KY
42101-8473
US

IV. Provider business mailing address

5925 LOUISVILLE RD
BOWLING GREEN KY
42101-8473
US

V. Phone/Fax

Practice location:
  • Phone: 270-320-4458
  • Fax:
Mailing address:
  • Phone: 270-320-4458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: