Healthcare Provider Details

I. General information

NPI: 1114050382
Provider Name (Legal Business Name): STEPHANIE RENEE' ALFORD ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE RENEE GRANT ARNP

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 03/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S MAIN ST STE 101
BROWNSVILLE KY
42210-9001
US

IV. Provider business mailing address

PO BOX 784
BROWNSVILLE KY
42210-0784
US

V. Phone/Fax

Practice location:
  • Phone: 270-975-4050
  • Fax: 866-809-8145
Mailing address:
  • Phone: 270-975-4050
  • Fax: 866-809-8145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3004713
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: